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HomeMy WebLinkAboutDrain Layers Permit 18 Heritage Drive TOWN OF SOUTH WINOSOR INSPEC-i 1:0N REPORT Perrylit No . 6769 Contractor J & H SLATER CONST CO Location 0018 HERTIAGE DRIVE Address 75 COMMERCE WAY Type Wort; NEW SAN LAl SOUTH WINDSOR CT 06074 Pkrorie No. 1860 )528-5252 Date T nsp Needed t 0` jnsp. { Sp Time I nsp Needed __. _-- _=- _ T i me T r) Inspected By Work: i n Progress Tnput, . _ __ Date , Hermit No. 57r,9 fawn of South Windsor , CST Permit Date urain Layer Permit Expiration Date 04j18/ 1996 Descrip : App I i can t 1_ocat i on Name J & H SLATER CONST CO Addr'. 001.8 HERTIACE DRIVE Addr. 75 COMMERCE WAY „ . Owrier ` Ruh`_F,ELLCO INC; , SOUTH WINDSOR CT 06074 ' Phone No. ( 860 )528-5252 The Drain Layer asslyn€d th'03 permit has a ' yai,id license issued by the state and hereby agrees- t&, al I''U46 terms and c©ndvtio�n set forth 'in the attached 'Conditions' : A`! l 'work sf^ra3 } �,bel, IIn accor,�danoe with Town of South Windsor standards , al k 0SHA r�equi rer►e'nta x and conditions . .� 1°�cued By Date Inspected _ '� - f _. Iri..pel:tefy ,r y. TOWN OF SOUTH WINDSOR SANITARY SEWER LATERAL , FIELD LOCATION DATE OF CONSTRUCTION: 3 20- q� BUILDING ADDRESS STREET : « f�Q�-ri'a Or✓7�� + SUBDIVISION: NORTH ARROW S, ' t 1 1 1 y k g { { , I 76 / ! - , I aiv. ,of i , IF{ , - A/ T44 7-6 1- aj6, sr CONTRACTOR (PRINT) NAME OF C NTRACTOR'S SUPERVISOR (PRINT) 7,5- Co r oe, we,-y - 3-.20-9P/ STREET ADDRESS e7- SIGNATURt W a r/I VY- 7 0 6 0'7`3/ TOWN STATE ZIP I SP TED BY TOWN 5 3-�3",� DATE TELEPHONE NUMBER WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER APPLICATION FOR DRAIN LAYERS PERMIT TOWN OF SOUTH WLNDSOR PUBLIC WORKS DEPARTMENT TOWN HALL 1540 SULLIVAN AVENUE SOUTH WINDSOR, CT FEE$25.00 Location of proposed work Lot # Street No. Street Name Premises owned by: IZ_ Name of Firm: j � 5�;- ' 2 Phone: Address of Firm: ti t rl uou- TYPE OF WORK: Lay House Drain�C _; Repair House Drain ; Lay Main ; Lay Lateral for Commercial/Industrial Building of acres Connection will be made with Proposed Start Date`5 -108 Estimated time for completion �-3. c1 ALL WORK TO BE IN ACCORDANCE WITH TOWN OF SOUTH WINDSOR STANDARDS, ALL OSHA REQUIREMENTS AND CONDITIONS ATTACHED TO THE PERMIT Permit is to be issued to j A-a � 4-kc L the holder of Drain layer's License No. Z(=;1749 Only holders of P1, P7 & W9 licenses will be issued a permit. Permit will expire thirty (30) days after date of issuance. The undersigned Drain Layer hereby agrees to all the terms and conditions set forth in the permit and attac ed thereto. Applicant has received Town Street Excavation Permit No. fv and/or ConnDOT Permit No. A Signed- ` .� "- Print Name j A t = W`:;44(E12 Licensed Drain Layer Date: