HomeMy WebLinkAboutDrain Layers Permit 35 Wildlife Trail (2) 750022 TOWN OF SOUTH WINDSOR, CT
-PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 07/06/07 >`'
GIS ID: 94400035
FEE: 60.00
MUNIS APPLICATI "° •.: � '>k<
ON# 200701038 ,> ;` "• ` .':< ; EXPIRATION DATE: 08/05/07
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NAME: FOLSOM CONSTRUC I ION T I O; ::+:<". `n .pRESV `*:<•':3 `WLDl FE TRAIL
ADDRESS: 138 RYE STREET y" f,! "`` E C
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SOUTH WINDSOR,GI l467 ::. .:'"':.. <r R 9 :in, 41INDY`HILL DRIVE
%'» €Z L3 INDSOR CT 06074
PHONE 860-528A 9'
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THE DRAI
N LAYER A SSIGNED T O THISpERM`T~.�� ..,� _
� . � . 7� �T� �' T��..S�: A HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORTU IX`*""�HL AtTAC 5 "I.?1�TS.'>': TL ORT SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDAI A LTfk I .RI J N 1 ND 1H�'tk7TACHED CONDITIONS.
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ISSUED BY DATE KSIPECTED INSPECTED BY
7/6/2007 3:30 PM
s
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: CONTRACTOR:
LOCATION:
TYPE OF WORK:
DATE INSP NEEDED: DATE INSP:
INSPECTED BY:
WORK IN
PROGRESS:
AS-BUILT:
INPUT: DATE:_
W/2007 Town of South Windsor INPSECTION REPORT 07
APPLICATION FOR DRAIN LAYER PERMIT
1 oG o TOWN OF SOUTH WINDSOR
�P 3 PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $60.00
Location of proposed work: Linc TrcniLLot #
Street No. Street Name
PFemlses owned by: 066c)
Name.of Firm:_ ® Phone:
Address of Firm: d9 s Q l/�rr�-�/ /-�i�� � kj A26S61
TYPE OF WORK:
Lay House Drai ; Repair House Drain
Lay Main ; Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with
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 SdH Acic dw LL tithe holder of Drain
Layer's License No. 20 f„(, . 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 and/or ConnDOT Permit No.
CBYD No. o2DO?-o?0— 3 p2 Z,►
Signed4,41,
Print Name:nsed Drain Layer
Date:
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc