HomeMy WebLinkAboutDrain Layers Permit 43 Wildlife Trail (2) 750024 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
41
DATE: 07/06/07 ;
; .
GIS ID:-94400043
'" FEE: 60.00
MUNIS APPLICATION# 200701041 '. EXPIRATION DATE: 08/05/07
APPLICANTff
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�::.LOCATI ON
NAME:
FOLSOM CONSTRUCTION>:. T3C::.......;;<:` ,,," I1ZSV ' WLDtIFE TRAIL
ADDRESS: 138 RYE STREET
TER 1 dEAD OW LLC
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SOUTH
WINDSOR,
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,5 .
H•W
:�:�' 06074
PHONE
860-52 $928- .:..8
WORK DES
CRIPTION:
ON: NEW
SE
, '
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THE DRAIN LAYER ASSIGNED TO THIS 4f RMIT BIAS.�>.XtA :>' 1 N 5 V.F3 „.' y:..:T..`f'.
(ET AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORTS INH < TA1I�kS'. W(1I2K'SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDAl:I?S -A' ,L, i I_T i.,. IT TH <;t I ACHED CONDITIONS.
s
ISSUED BY DATE TNSPE MD x INSPECTED BY
7/6/2007 3:44 PM
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: CONTRACTOR:
LOCATION: 70 'k) 1 �-J
TYPE OF WORK:
DATE INSP NEEDED: DATE INSP:
INSPECTED BY:
WORK IN
PROGRESS:
2
AS-BUILT:
INPUT: DATE: '(.S'a 7
W/2007 Town of South Windsor INPSECTION REPORT 07
APPLICATION FOR DRAIN LAYER PERMIT
" TOWN OF SOUTH WINDSOR
R G 0/00 JUBLIC WORKS DEPARTMENT
a 0 �✓ TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $60.00
Location of proposed work:A W,16 11. iG Lot # '
Street No. Street Name
P.
Name of Firm: 0h A/ Phone:
Address of Firm: 0 to ,via (e_j,
TYPE OF WORK:
Lay House Draiw Repair House Drain
Lay Main ; Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with SZ) 1CS
Existing Water Supply: rllEs�tlmat
r Well
Proposed Start Date� ed 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 toA.0" C_ek-P4 LL the holder of Drain
Layer's License No. . 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.2 7
Signed• c/ Print Name: Fa
-censed Drain Layer
-----
Date:— _ D
Standard FormsTermitsWPLICATION FOR DRAIN LAYERS PERMIT.doc
TOWN OF, - SOUTH ANDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE. OF CONSTRUCTION:
BUILDING ADDRESS 9,3
STREET ' 4
SUBDIVISION: r ► e �.�, ` �<
NORTH ARROW
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ir
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CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPERVISOR (PRINT)
Of ,e gc, '
STREET AD RESS SIGNATURE
cP�6 I'` G DATE
TOWN _ _ _ - STATE ZIP INSPECTED BY TOWN
DATE
TELEPHONE-NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW CONSULTING ENGINEER / DEVELOPER