HomeMy WebLinkAboutDrain Layers Permit 53 Lavender Lane r
TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. Contraz'— JACQUES: CONSTRUCTION (JOHN)
Location 3
-�� , iE .._ '6 7 RIDGE. ROAD.
Type Work NEW SAN LAT UTH WINI7:$OR C _ 06074
phone No (66,.4'!32 "1-823
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Date Insp Needed
Time Insp Needed ----------- ^_ TLm I ..- -
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Inspected By ��..�.�,
Work in Progress 6.{ c�ro✓
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Permit No. 8074 Town of South Windsor, CT
Permit Date 07/27/2006 Drain Layer Permit
Expiration Date 08/26/2006
Descrip: INSTALL SEWER LATERAL'
Applicant LpCa.t$on
Name JACQUES CONSTRUCTION {JOHNN 3 I.F'VtNDEIR LANE .
Addr. 67 RIDGE ROAD OWT;er JMJ
SOUTH WINDSOR CT ,06074
Phone No. (860)432-1823. '
The Drain Layer gssi'gned, ally perkifi hs.s a ua id. 1`scense ,assued by the
state and hereby agrees to ail:. the 'erms' a'nd cvriditao.ns Set::;'forth in the
attached 'Cond i t i n s A'I 1`:..: ` «::;:.;.:;; :: >: `;`<'s'::::>«::>:<:::<:>;:.;::>::>>:: .:?.;;>>. .::.
o mark shzl . zri acordan � wzt.kj Town of South
Windsor standards, aft OSI�A"xe`n `�'�:m 'ts, a�i�l �.,k#e att:ahed::..:cori'ditions.
Issued B cJ� �1i�W Patle. .. ., e.IC �s
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Date Inspected ________ Ifisp' ct d"'By
48o1 4-
APPUCATION 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:
Street No. Street Name
Premises owned b
- Name of Firm: - - . Phone: jj0(o ?,S
Address.of Firm:
TYPE OF WORK:
Lay House Drain________; Repair House Drain
Lay Maln : • Lay Lateral'for Commercial/Industrial
Building of acres
Connection will be made with J .h Q
Existing Water Supply: Public Water ✓
Well
Proposed Start Date 7 ?,
Estimated time for completion l� l
ALL WORK TO BE IN ACCORDANCE WITH-TOWN OF SOUTH WINDSOR STANDARDS
ALL OSHA REQUIREMENT'S AND CONDITIONS ATTACHED TO THE PERMIT
Permit-is to be issued to ,�- �—
Layer's License No. 0 the holder of Drain
will be issued,a my holders of P-1, P-7 or W-9 licenses
permit: PERMIT WILL E PIRE 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: co(U140C
Lice 12d r;qrALaver
-- - -
Date:
Standard F0M1s\Perm1fs\APPLICATI0N FOR DRAIN LAYERS PERMIT.doc
TOWN OF SOUTIVNDSOR
SANITARY - SEWER LATE RAC LOCATION
DATE OF CONSTRUCTION:
-BUILDING ADDRESS J,6 7L :
STREET
SUBDIVISION:
NORTH ARROW -J
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3
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C1 c S t/c' SU !/
CONTRACTOR (PRINT) NAME 0 ONTRACTOR'S ERVISOR (PRINT)
STREET ADDRESS SIG
NIZZz7/I
DATE
TOWN STATE ZIP INSPECTED BY TOWN
`-/ - - - - --_ DATE
TELEPHONE.NUMQER
WHITE - TOWN PINK.- CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER
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