HomeMy WebLinkAboutDrain Layers Permit 28 Kelly Road 750036 TOWN OF SOUTH WINDSOR, CT
PEP,MIT NUMBER DRAIN LAYER PERMIT
DATE: 08/06/07
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GIS ID:49500028 `'
FEE: 60.00
MUNIS APPLICATION# 200701230 EXPIRATION DATE: 09/05/07
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APPLICANT OCATION
NAME: SKIPS SEPTIC . . ISS ::'"'2$° LI'3ROAD
ADDRESS: 27 MUDDY BROOK ROAD. QES DEMOT T&DENICE L
ELLINGTON CT 0602a.:.<"';
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SoUb TM-W NDSOR,CT 06074
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PHONE 860-875-2 3�-:€W RK DESCRIPTION: E ON W S Eumv
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THE DRAIN LAYER ASSIGNED TO THIS(I' 2MIT � t<<yLZ-, s4tI3` .: STN'T'E AND HEREBY AGREES TO ALL
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THE TERMS AND CONDITIONS SET FORTH J S'. t L VC 'SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDAkD9 ALL O I A3 E � T ,AID THL:A11`ACHED CONDITIONS.
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ISSUED BY DATPJ'TNS'PECT D INSPECTED BY
8/6/2007 2:42 PM •
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: ;5_-0_��� CONTRACTOR:��
LOCATION: 0 P l
TYPE OF WORK: /'1LJ
DATE INSP NEEDED: DATE INSP: o
INSPECTED BY: G 1)
WORK IN
PROGRESS:_ C"+ra-c.dar .,s � (a"�q0 vc-
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INPUT: C�`�' DATE:
W/2007 Town of South Windsor INPSECTION REPORT 07
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: 2-g krlu e y X—P Lot #
Street No. Street Name
Premises owned by:
Name of Firm: Yk (P s S'C P71 C. Phone: S? SZ 3 3 Z
Address of Firm: G • I?ot)( 2- 104-L. tr4 67v C 7_�
TYPE OF WORK:
Lay House Drain K ; Repair House Drain ;
Lay Main ; Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with PVC
Existing Water Supply: Public Water X Well
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Proposed Start DateL�3 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 -M� the holder of Drain
Layer's License No. 7o,7,7 2 S— 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. v2007 32-oo 3 -3
Signed: Print Name: G✓A'�Lk
Li ensed Drain Layer
Date: _
standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: " V,' `>-
BUILDING ADDRESS • k al
STREET
SUBDIVISION:
NORTH ARROW
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CONTRACTOR (PRINT) NA OF CONTRACTORS SUPERVISOR (PRINT)
STREET ADDRESS SIGNA E
C 1-L 1 N�"TT I �:� I✓G j 1,1 81Ls1 o7 DATE
TOWN _ STATE ZIP INSPECTED BY TOWN
to 1 %ti L, DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER