HomeMy WebLinkAboutDrain Layers Permit 92 Lavender Lane 750012 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER
DRAIN LAYER PERMIT
DATE: 05/16/07 "�>' . . "0 " `::
GIS ID: 52600092
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MUNIS APPLICATIONkf.` FEE: 60.00
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;: .:.;..:4::. fr _;EXPIRATION;, DATE: 06/15/07
APPLICANT' :. '
NAME: JACQUES CONSTRUTIQN. >>->.r >:' ;<='r.':.
Al
~32;IiOCATION
~AVEIER LANE
ADDRESS: 67 RIDGE ROAD .y
`'.;> '.< a;,;.. R• IIvTJSRUCTION CO INC
SOUTH WINDSOR,
LLIN(">yTON ROAD
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PHONE I `�VI1DS CT 06074
860-432-�82.3.. '
WORK DESCRIPTION: NEW
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RA AS
SIGNED
GNED TO THIS rK
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AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORTHN SHE AAMUT
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� SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDARL3 , O.S T.S'Ap;J1 :7IF ATTACHED CONDITIONS.
ISSUED BY DATE INSPECTED INSPECTED BY
5/16/2007 3:47 PM
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: 9 g 101/. ��i 4Lot # /O
Street No. Street Name
Premises owned by: cats
Name of Firm: Phone: 4-S.a- 0 6 G 8
Address of Firm:—
TYPE OF WORK: /
Lay House Drain ✓ ; Repair House Drain
Lay Main ; Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with S M, 3�
Existing Water Supply: Public Water ✓ Well
Proposed Start Date Estimated time for completion lbbt
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 )�7-mT s the holder of Drain
Layer's License No. DO 513 30 my holders of P-1, P-7 or W-9 licenses
will be issued a permit. PERMIT WILL EEXPIRE 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: �oA ��te S
Lice ed Layer _
Date: -2
-- -- — standard Forms\PermitMPPLICATION FOR DRAIN LAYERS PERMIT.doc
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TOWN OF SOUTH WINDSOR
SANITARY - SEWER LATERAL FIELD LOCATION
DATE. OF CONSTRUCTION: l /67
BUILDING ADDRESS :
STREET : L A- i/O E 0. L 4 1V E
SUBDIVISION: _ T-ea .e lr w r:-
NORTH ARROW
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CONTRACT i(PRI NAME OF CONTRACTOR'S SUPERVISOR (PRINT)
ELT ZI)REW
/ SIGNATURE
D�C> 7 5�.�.,...� S•12�1�� DATE
TOWN STATE ZIP INSPECTED BY TOWN
g' �� ��' DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: 7 ®° 1'L , a
LOCATION: ADDRE
SS:
TYPE OF WORK: NPW ®n
DATE INSP NEEDED: DATE INSP: o
INSPECTED BY: (3
WORK IN
PROGRESS'
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INPUT: Co AA�-, DATE'