HomeMy WebLinkAboutDrain Layers Permit 39 Wildlife Trail (3) -750023 TOWN OF SOUTH WINDSOR, CT
PERN�NUMBER DRAIN LAYER PERMIT
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DATE: 07/06/07 <�
GIS ID: 94400039i,u
FEE: 60.00
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MUNIS APPLICATION# 200701039 a. Am, M EXPIRATION DATE: 08/05/07
APPLICANT
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NAME: FOLSOM CONSTRUCTIOI4r <
ADDRESS: 138 RYE STREET '+ ,:: :.. ' .<::: : .k .+.,: R: . ER MEAD OW LLC
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THE DRAIN LAYER ASSIGNED TO THIS FERMIT<�IA&�:::�IAI, 5 LIF}D iT ST 'TE ANIPRESiB AGREES TO ALL
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THE TERMS AND CONDITIONS SET FORTH IN.`Vh�'.TA.-.. y':-k-WO1 �C I?�S'.;<t�I �VC�I�'SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDAI�SOALL D HA'' 'ummomm AN 7 THE<t1 TACHED CONDITIONS.
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ISSUED BY DAT R SPECTtD INSPECTED BY
7/6/2007 3:37 PM
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: ,3 CONTRACTOR: n-\-
LOCATION:
TYPE OF WORK: A ((?c1l) •
DATE INSP NEEDED: DATE INSP:
INSPECTED BY:
WORK IN
PROGRESS:
AS-BUILT:
INPUT: DATE: ?� S :0 -7
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W/2007 Town of South Windsor INPSECTION REPORT 07
rer�A 4- 7S-, p70
APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
7G PUBLIC WOWN HALLRTMENT
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1540 SULLIVAN AVENUE
SOUTH WIN'DSOR, CT
FEE $60.00
Location of proposed work: W i L L Lot #
Street No. Street Name
Premises owned bi F, P..,o44 Uad AArF
Name of Firm: v A4i Phone,
Address of Firm-4�i Ili It 1�__12
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TYPE OF WORK:
Lay House Drain ; Repair House Drain
ain ; Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with
Existing Water Supply: Public Water Well
Proposed Start Date '7 a Estimated time for completion
ALL WORK TO BE IN ACCORDANCE WITH TOWN OF SOUTH WINDSOR STANDARDS,
ALL OSHA REQUIREMENTS AND CONDITIONS ATT CHED TO THE PERMIT
Permit is to be issued to ® Sly N a*v 11,4,the holder of Drain
Layer's License No. 20 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
Sign _ ""— Print Name:
censed Drain Layer
Date: `" 0-7
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc
TOWN OF SOUTH A.NDSOR
SANITARY SEWER LATERAL/FIELD LOCATION
DATE OF CONSTRUCTION: 07
BUILDING ADDRESS
STREET
SUBDIVISION:
NORTH ARROW
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CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPERVISOR (PRINT)
STREET ADDRESS SIGNATURE
DATE
---TOWN --- - STATE ZIP INSPECTED BY TOWN
DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER