HomeMy WebLinkAboutDrain Layers Permit 110 Joseph Lane TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 7878 Contraar'ft WIhC'O'X1-- MICHAEL (EAGLE)
Location 0110 JOSEPH LANE EAG'.E ;&ARTTIW;ORK SERV.
Type Work NEW SAN LAT
i N M:OI#YYTAIN:>.;ROAD
CANTON='•CT 4601.9
' l �d�I Phone i�o (�60)693 2Q27
Date Insp Needed a? 0(� o� Dates Iztsp `
Time Insp Needed Time Iin,
Inspected By
Work in Progress ... F� : Pd '
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Permit No. 7878 Town of South Windsor, CT
Permit Date 02/14/2005 Drain Layer Permit
Expiration Date 03/16/2005
Descrip:
Applicant
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L. .. a ..
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Name WILCOX, MICHAEL (EAGLE) Adr Q} 0 JOSEPH LANE
Addr. EAGLE EARTHWORK::SERV ' dw-:her.. MANNAR NQ BUILDER$ INC
101 N MOUNTAIN ROAD;
CANTON CT. 0.6D19 . '
Phone No. (860)693-2027.-:
The Drain Layer assgried tis1tY�t kts amid 3'icner.asxed by the
state and hereby agrees to a 1 -the term " hd c'cindit. ni�a .Set forth in the
attached Condi i ::..:.:::.. » ,:.:;::•
t ons,. ::: sh:a5 <; :;Cpt :danee:-3.t.h Town of South
Windsor standards, all OSHA requirements; Rind the attached ;.eonditions.
CIssued By --------- T.
— ----------------
Date Inspected Y'n'specte'd' By
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: //0 4o w� Lcm,(P Lot #
Street No. Street Name
Premises owned by: LJZL(�"(;
Name of Firm: je F'o ® Phone:
Address of Firm: Gg0 v * &ad,
TYPE OF WORK:
Lay House Drain�V _; Repair House Drain ;
Lay Main ; Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with �ceellL°
Existing Water Supply: Public Water Well
Proposed Start Date 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 (cof" the holder of Drain
Layer's License No. 2-7 L f 6 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.
64 4�kl c(
Signed: Print Name: ����� I�bC
Licensed rein Layer
Date: - —A—
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc
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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