HomeMy WebLinkAboutDrain Layers Permit 91 Joseph Lane TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 7831 Cont CHAEL (EAGLE)
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Location 0091 JOSEPH LANE AO reg. I��g :x�rAGL�`k'^E1}1jTIiWt;1RK SERV.
Type Work NEW SAN LAT 1 1 N M U Il;"RQAD
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Permit No. 7831 Town of South Windsor, CT
Permit Date 09/30/2004 Drain Layer Permit
Expiration Date 10/30/2004
Descrip: u s
Applicant
`'`
`V{ LCScat#on
Name WILCOX
, MICH k AEL fi
:cam ;»k; :: s.00Y9 ° NE`t
Addr. EAGLE EARTHWORK DERV`: fi.<. .a.,
r MANNAR�;��,,O'BfI;IIPSRS�> INC
101 N MOUNTAIN
CANTON �C.. b
Phone No.
(860)693-2
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t:$`i
The Drain Layer y:`z(
s`F ;sY ?.d 1:3c'ens:� s ,ed
state �i' t :: t 3 5.:.u by the
and hereby ag ,g>,<>.t `<<; `2 �im ' 323'` 3�tan `.. t;.'forh in the
attached 'Conditions,i �� 1 Wo le;z?. :a::>x�': >"..�sn>. 3 f {;,.
•zfMI
d ':ssyt}? T5 31 of South
Windsor standards, a i't OSFA <a. c "" < `� '` Y c 'ui' �t{ •Gg; sa' E'`attaiec,,_c.onclitions.
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Issued By
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 work:( b'A! Lot'.# l
Street No. Street-Name
r owned y: e
Name of firm Phone:. 7
Address:of Firm:_. la?
TYPE OF WORK:
Lay House Drain • Repair House Drain •
Lay Main - •
Buildin
g-____,._.—____;oLay Lateraf for Commercial/Industrial
Connection will be made with eve
Bdsting Water Supply: Public Water- . r_ ___:_ Well
Proposed Start Date /d- / 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. __ 2 7b 1 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 Na
.CBYD No.
Signed: Print Name:_ d Au L
'censed Drain-Dyer - - -- _
Date: -Z
Standard F0rms\Pern)it5\APPLICg10N-FOR DRAIN LAYERS PERMIT.doe
TOWN OF I ! I '
SANITARY SEWER LATERAL 'FIELD LOCAT.10N
DATE. - 6gro,-.pwd , sir
16
BUILDING ADDRESS
STREET !2
SUBDIVISION: ` ♦ �
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Owns
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TOWN OF SOUTH ANDSOR
SANITARY SEWER LATERAL 'FIELD LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESSr7 L o
STREET
+ SUBDIVISION:
NORTH ARROW
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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