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HomeMy WebLinkAboutDrain Layers Permit 16 Lavender Lane 750040 TOWN OF SOUTH WINDSOR, CT PERMIT NUMBER DRAIN LAYER PERMIT GATE: 08/14/07 .14 GIS ID: 52600016 y 2`3 FEE: 60.00 MUNIS APPLICATION# 200701277 ``. EXPIRATION DATE: 09/13/07 s'< APPLICANT 3 NAME: JACQUES CONSTRUCTIOAT.-.(J�`��N)..`<<E'' "" '�'t";��i�r� �5�>' `]�;���EIOER LANE ADDRESS: 67 RIDGE ROAD S RUCTION CO <ti R:.a�, ' ,Tly[T: ON INC SOUTH WIND ,,,3<., y :. I L fNdTON ROAD SO�T II�D CT 0607 4 PHONE 860-432-1$2�33: ,... WORK DESCRIPTION: NEW SE SCRIPTI V 'i -tiw`.n,`yP, THE DRAIN LAYER ASSIGNED TO THIS PTtMIT IAtYI. 3s� .3IZ I STAVE AND HEREBY AGREES TO ALL THE TERMS AND CONDITIONS SET FORT'II;IN 7'H$y TTA .S'. ;t t W(Y.:—,SHALL BE IN ACCORDANCE WITH THE TOWN OF SOUTH WINDSOR STANDAI S t EL`C3 •1 i i1 T.19,iAl!� I"THE 1;TTACHED CONDITIONS. ISSUED BY DA E [P'S`PE=D f INSPECTS BY 8/14/2007 10:08 AM 4 TOWN OF SOUTH WINDSOR INSPECTION REPORT PERMIT NO.: a d CONTRACTOR:_,_o A tJ �� - LOCATION:_16 Ga�'rl�nc��� Ld n P TYPE OF WORK:_ Ive Uj (o rn V1-ec�i0 h DATE INSP NEEDED: DATE INSP: INSPECTED BY: WORK IN PROGRESS:_ 11 v Lt/�- �✓Ic JV �`r/tt�t q 6/'"7m 094, � 3/��f C AS-BUILT: t� INPUT:_ G ham-- DATE:_ D 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: A� (Z°��z Lot # Street No. Street Name Premises owned by: -1 C© G ' Name of Firm: Phone: 'obi Address of Firm: TYPE OF WORK: Lay House Drain ; Repair House Drain ; Lay Main ; Lay Lateral for Commercial/Industrial Building of acres Connection will be made with Q am� Existing Water Supply: Public Water Well Proposed Start Date b Estimated time for completion P14 ALL WORK TO BE IN ACC RDANCE WITH TOWN OF SOUTH WINDSOR STANDARDS, ALL OSHA REQUIREMENTS AND CONDITIONS ATTACHED TO THE PERMIT Permit is to be issued to T the holder of Drain Layer's License No. 0 IT 3!o 0 ly 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: Print Name: ec��� Licen rwL-S'y-er Date: -- standard Forms\Per its{APPLICATION-FOR DRAIN LAYERS PERMIT.doc - TOWN OF SOUTH ANDSOR ,SANITARY SEWER LATERAL FIELD LOCATION DATE OF CONSTRUCTION: BUILDING ADDRESS STREET SUBDIVISION: � NORTH ARROW 7 2 --------------- Ak --- - _J_L � !►'1� Ad 1 ioti CONTRACTOR (PRINT) ;GNATURE M OF CONTRq OR'S 7RVISOR (PRINT) (SrB 6b'u 6-Mkl 4o4 -c STREET ADDRESS wfo AliI c C� Dom? TOWN STATE ZIP INSPECTED BY TOWN DATE TELEPHONE NUMBER WHITE - TOWN PINK CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER