HomeMy WebLinkAboutDrain Layers Permit 295 Rye Street 750032 TOWN OF SOUTH WINDSOR, CT
PERMAT NUMBER DRAIN LAYER PERMIT
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DATE: 07/31/07 µ�'A
GIS ID:78600295 =...,'� FEE: 60.00
0 T DATE: 08/30/ 7
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EXPIRATION 200701 96 M IS APPLICATI N#O UN
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TEETDRES �,« •2�5 YENAME: J&H SLATER CONSTO :. , IJ HEPAR D ASSOC IATESIADDRESS: 75 COMMERCE WA ?" 1`' W'EST74:SOUTH WINDSOR,4>Tb0 RD
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LD CT 06002
PHONE 860-528=bz'Sl`
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WORK DESCRIPTION: TE O1�, , )k � � _ 13A
USING L1 TL Ai" ( :< 7Z. ' <..§TR D:RESIDENCE
THE DRAIN LAYER ASSIGNED TO THIS'I'ERIvl T
�HAS'i^XACISII BI'TIDE;=S SATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORiV IIHE':ATTA 'Yl1VS/fAT WOI? SHALL BE IN ACCORDANCE WITH
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THE TOWN OF SOUTH WINDSOR STANDARD.9"ALL `R I �I�j1 �ANIa SHE�fiTACHED CONDITIONS.
ISSUED BY DATEIRSPECTED INSPECTED BY
7/31/2007 3:01 PM
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: CONTRACTOR:
LOCATION:
TYPE OF WORK:
DATE INSP NEEDED: DATE INSP: 0
INSPECTED BY: e\'�
WORK IN
PROGRESS: 'f,o
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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:_ 95� le Lot #
Street No. Street Name
Premises owned b nv
Name of Firm:/ /�ems/(..l_ /0 Phone: 3/7--
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Address of Firm: 4 /' y
TYPE OF WORK:
Lay House Drain_; Repair House Drain ;
Lay Main ; Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with 1� Y 16Y6
Existing Water Supply: Public Water_ Well
Proposed Start Date g Estimated time for completion z
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. 2a 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
erevv and conditions set forth in the permit a attached thereto. Applicant has received
Town Street Excavation Permit No. and/or ConnDOT Permit No.
UJ CBYD N .
Sign Print Name: J 50
Licensed Drain Layer
Date: 7 3f
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Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc
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STREET lRf=SS ' T SIGNATURE
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WHITE TOWN r PINK. CONTRACTOR YEL m CONSULTING ENGINEER / DOELOPER
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
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CONTRACTOR (PRINT) NAME OF WNTRACTOR'S SUPERVISOR (PRINT)
STREET ADDRESS 04 7 y SIGNATURE
TOWN STATE ZIP INSPECTED BY TOWN
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TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER