HomeMy WebLinkAboutDrain Layers Permit 3 Kingsley Drive r 1
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 7005 Contractor GERBER CONSTRUCTION CO j
Location 3 KINGSLEY co�T`��- Address 616 DART HILL ROAD
Type Work NEW SAN LAT x , VERNON CT 06066
Fhgne =No. (860)875-6684
Date Insp Needed 3
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Time I nsp Needed17
Inspected By
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Work in Progress /iy, 2� 5
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Permit4No.. 7005 Town of South Windsor, CT
Permit Date 06/18/1999 Drain Layer Permit
Expieatjon Date 07/18/19.99
Descrip: CK 10016 FOR 6 LOTS
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Applicant Location
Name GERBER CONSTRUCTION CO ,. ddr 4 3',kCTNGSLEY
Addr. 616 DART HILL ROAD twar HAKE ASSOC.
VERNON CT ,6G$6 ,' t
Phone No. (860)875-6684
x The Drain Layer as i, r�eiah sir hes�� V .1 cense issued by the
state and hereby agreeio tl e `end1E�1 it# 1s set forth in the
attached 'Conditions' . A ftkha 1' n a in with Town of South
Windsor standards , all,, "- ids4;6 ,t ched conditions.
Issued By
Date Inspected �� �T=� �x s � ti
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS L � '
STREET : K
SUBDIVISION: S� rc ,rdt
NORTH ARROW
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CONTRACTOR (PRINT) NAME OF CONT TOR'S SUPERVISOR (PRINT)
STREET ADDRESS SIGN AT
\1 �(,jU� 0 6 a G DATE
TOWN STATE ZIP INSPECTED BY TOWN
- F?O q 15 _Cis DATE
TELEPHONE NUMBER_
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER
APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Location of:proposed work:
Street No, r et Name Lot #
Premises owned by: kAJA_ s
Name of Firm: c. Phone:__��y
Address of Firm:-Jo/4 pq aw g) C&AJIA11
TYPE OF WORK:
La Hou
se use Drain , Repair House Drain
Lay Main ; Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with - �rll�
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 �� C o.� t,
Layer's License No. A2 2�8�1(Z/ the holder of Drain
ire thirty Only holders of P1, P7 & W9 licenses will
be issued a permit. Permit will expire rty (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.
Signed: Print Name:
Licensed Drain Layer
Date: �h 7
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMrr.doc
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