HomeMy WebLinkAboutDrain Layers Permit 415 John Fitch Boule TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 7849 Contra cr-19MS"P'L .INC.
Location 0415 JOHN FITCH BLVD ., ,
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Permit No. 7849 Town of South Windsor, CT
Permit Date 10/27/2004 r'"` Drain Layer Permit
Expiration Date 11/26/2004
Descrip: DISCONNECTION OF SANi'TAR fA A�iRA 2
Applicanton
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Name BESTECH INC.
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Addr. 25 PINNEY STREET.": > y r VANCO AT ES jJ
ELLIN GT ON G'4r'•=�0 6��<�,z. r. :' 'z f s , ��,{a:;"``:<,,.: ::
Phone No "
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The Drain La yer 5i:d ::. 15'`>:.':. :: s. "a.rl. J�i,cris'eza `7.
ed by the
state and hereby agPee,W't 'Q.j,''u::the Termsd c it,1a.�}< :<:se <,,fox h in the
attached 'Conditions). ..: :«;.u,.-
' ll::wk„ 'ITy1 eS3'd. `e" 3t1? Tobin of South
Windsor standards, all OSHA'' eueitiZ ;.,.`. f <`;?1le a t�'acheConditions.
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Issued By —=+fP---- � � .T�t1
Date Inspected -------------------- By ---------------------
• 00 -29. 2004 11 :120 110.0883 P, 1
APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALT_
1S90 SULLIVAN AVENUE
SOUTH WINDSQR, CT
FEE $60.00
Location Of proposed work.; 4� 'an P44 DIU l pt#
Street No. Street Name
Premises awned by; Ka I�A v "OR jL t
Name of Firm:-- IahC�r�e�
---�-- --
Address of Firm, y . r-19 vz4K 02, +v
TYPE OF WORK:
Lay House Drain - , Repair our 1n
Lay Maine Lay Lateral for Cornmereial/Industrial r
Bullding-._._._,�or-acres
COnM(tion will be made with
Existing Water Supply: Public Water Well
Proposed Start gate Estimated time for completion
ALL WORD TO BE IN ACCORDANCE WITH TOWN OF SOLM i WINDSOR STANDARDS,
ALL OSHA REQUIREMENTS AND CONDITIONS ATTACHED TO THE PERMIT
Permit is to be issued to Rota4 ! ��" the holder of Drain
L,avers Llcenw.No. 0'2075' , Only holders of P-X, P-7 or W-9 licensss
will be issued a permit. PERMr'>I•'WILL EXPIRE rHIRTY(30) CLAYS AFrER
DATE OF ISSUANCE. The Undersigned Drain Layer hereby agrees to all the terms
and conditions set forth in the permit and attached thereto. A,pplicatlt has received
Tawrr Street Excavation Permit No. and/or ConnDQT Permit No,
CBYD No, Qa o"R
Signed Print Name:._. �r
Licensed rai6'w-. r
Date:
. . . ,. 5tasid�r�.Forms\ikvmi��JlPPliC2R�oN IFQR DRAIN VlY�C5�FiM1T,000 ,. .
TOWN OF SOUTH ANDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: I /Dq
BUILDING ADDRESS : IA 14 is. V C4nlek
STREET c4l �, �.�— YSI 4
41 SUBDIVISION:
NORTH ARROW
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31
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CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPERVISOR (PRINT)
STREET ADDRESS SIGNATURE
20 IA 9 It Q4x!� it, t -t— D� y7 ���� �/���y DATE
TOWN STATE ZIP INSPECTED BY TOWN
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oc
l l y V DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER