HomeMy WebLinkAboutDrain Layers Permit 78 Joseph Lane TOWN OF SOUTH WINDSOR INSPECTION REPORT
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Permit No..,.,,, Cont;xactor WILCOX ;KICHAEL (EAGLE)
Location Acdresfi.r GLE EYRTHC)'ORK SERV.
Type Work NEW SAN LAT " .. `
MOUNTAIN"ROAD
CANTON -CT 0 60,19
Pltione No C860)693 ZO27
Date Insp Needed �� bite Tr's
Time In s Nee
ded
Inspected By �—w(M.1 ----4
Work in Progress — ---- ----- �vy,�1 -� 1► ,.4
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Date
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Permit No. 7965 Town of South Windsor, CT
Permit Date 09/21/2005 Drain Layer Permit
Expiration Date 10/21/2005
Descrip: USER FEE PREVIOUSLY ,t?AID
Applicant
Lo::aC`1on
Name WILCOX, MICHAEL (EAGLE) Ad �07 ]QSEPIAIIE
Addr. EAGLE EARTHWORK SERV: :, . INC
;
101 N MOUNTAIN I2GA,p.
CANTON CT 0 .'019 r
Phone No. (860)693-2027;; .;'
The Drain Layer asslgri d .Ch s e C4fit his y J id l (`: nse A�sued by the
state and hereby agteqs�tb:-;:2Rl::.the` t' 'rms' r1`d Cdr `3't. ri"":»s`t<'"for.th in
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attache
d 'Conditions!
;. ,.� xs. a �e with Tb�sn of South
Windsor standards, all OSHA rcquizettizxts and t}�e attached conditions.
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Issued By
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Date 'Inspected "'
APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $60.00
Location of proposed /p p sed work. *treet
r�?i� Lot #
Street No. Name
Premises owned uiy.-. fit 16
Name of Firm: Phone:
Address.of Firm:_ 41t hl�nCf'!� riI k--_41V
TYPE OF WORK:
Lay House Drain Repair House Drain
Lay Main • Lay Lateral-for Commercial industrial
Building Of acres
d ,/��
Connection will be made with (-l��
Existing Water Supply: Public W Well
Proposed Start Date f. yt Estimated time for completion
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 the holder of Drain
Layer's License No. Only holders of P-1, P-7 or W-9 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 attached thereto. Applicant has received
Town Street Excavation Permit No. and/or ConnDOT Permit No.
CBYD No.
Signed:_aA Print Name: 610�cta LQ;few
License*Dr
* ` Layer
Date:
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc .
TOWN OF SOUTH r OR
SANITARY SEWER LATERAL FIELD LOCAT.1,0N
DATE. OF CONSTRUCTION: -
BUILDINGADDRESS
STREET
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SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION:
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CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPERVISOR (PRINT)
STREET ADDRESS SIGNATURE
DATE
TOWN STATE ZIP INSPECTED BY TOWN
DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER