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HomeMy WebLinkAboutDrain Layers Permit 87 Lavender Lane 750019 TOWN OF SOUTH WINDSOR, CT PERMIT NUMBER DRAIN LAYER PERMIT DATE: 06/19/07 o GIS ID: 5260008760.00 MUNIS APPLICATION# 200700918 << EXPIRATION DATE: 07/19/07 Y w' APP :.r ;> . ';LOCATION NAME: JACQUES CONSTRUCTION' O AD_ RES .' 8� L,::f.'AVE ER LANE ADDRESS: 67 RIDGE ROAD OO.STRUCTIONCOINC <:CN: SOUTH WINDSOR,C I#F074'; T✓LMTON ROAD v :: z II. D .., �. I1�1 SOR CT 06074 PHO NE - z 86 0-432 I WORK DE S RI C PTI ON: NE W SE A _;.:,, ;:::: THE DRAIN LAYER ASSIGNED TO THIS WERMt"A§A'�AL ET I SSI D.;B THE,STATE AND HEREBY AGREES TO ALL THE TERMS AND CONDITIONS SET FORTE IN'* IP"AN'TTt k I C AIS>°;,AFL';>S 4RI SHALL BE IN ACCORDANCE WITH THE TOWN OF SOUTH WINDSOR STANDAI 3;ALL 13S A RF 3 $tv-AND T-HL"A `TACHED CONDITIONS. as . ISSUED BY DATE I ' ' CTED INSPECTED BY 6/19/2007 2:14 PM 4 TOWN OF SOUTH WINDSOR INSPECTION REPORT PERMIT NO.: 7 5 00 ( � rnnn-oar-,-„R. LOCATION: ADDRESS: TYPE OF WORK: DATE INSP NEEDED: DATE INSP:�? � ® 7 INSPECTED BY:_ j� WORK IN PROGRESS: I_tcr Is INPUT: C" DATE: APPLICATION FOR DRAIN LAYER PERMIT TOWN OF SOUTH WINDSOR PUBLIC WORKS DEPARTMENT OWN HALL 1540 SULLIVAN AVENUE SOUTH WINDSOR, CT FEE $60.00 Location of proposed work: 907 ,*�JCr/l�t� /r, ot L # Street No. Street Name Premises � � Name of Firm: Phone: Q� Address of Firm: (of )4 v, RcL . TYPE OF WORK: Lay House Drain ; Repair House Drain Lay Main ; Lay Lateral for Commercial/Industrial Building of acres Connection will be made with 5 pR 35- Existing Water Supply: Public Water. ✓ Well Proposed Start Date 0 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 the holder of Drain Layer's License No. ZID'C'7`a© On 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. Signed: Print Name: 1' . Licen D Layer Date: - - -- - - Standard Fo s\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc TOWN OF SOUTH ANDSOR SANITARY SEWER LATERAL FIELD - LOCATION DATE OF CONSTRUCTION: 7/ a LA Vfn Deg' BUILDING ADDRESS e STREET : r SUBDIVISION: NORTH ARROW AA del �� vL T CONTRACTOR (P ) NAME OF CONTRACTOR'S SUPERVISOR (PRINT) STREET ADDRESSY SIGNATURE v I DATE TOWN STATE ZIP INSPECTED BY TOWN - _ - - DATE TELEPHONE NUMBER WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER