HomeMy WebLinkAboutDrain Layers Permit 43 Loomis Road 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: ►iS
Lot
Street No. Street Name
Premises owned bye
Name of Firm: —=-- Phone:
Address.of Firm: ��
TYPE OF WORK:
La House D
y rain , Repair House Drain - •
Lay Main - • Lay Lateral'for Commercial/Industrial
Building .of
acres
Connection will be made with R
Existing Water Supply: Public Water well
Proposed Start Date*—ad
Ale
Estimated time for completion Yb
ALL WORK-TO BE IN ACCORDANCE WITH-TOWN OF SOUTH WINDSOR STANDARDS,
ATTACHE
ALL OSHA REQUIREMENTS'AND CONDITIONS D TO THE PERMIT
Permit-is to be issuet&e�
Layer's License No. the holder of Drain .
• O lY holders of P-1i 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.- Lam. Print Name: rc=,
Licen D
Date: O
Standard F \Permits PL,ICATION FOR DRAIN LAVERS PE
RMIT.doc
TOWN - OF1 O '
SANITARY - SEWER LATERAL FIELD LOCATION
1A OF 1 _ /oy
BUILDING ADDRESS
STREET
SUBDIVISION: D, lwF57MeS
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No 7$2 Con.teactor. JMJ C N TRUCTION CO.
Location ex` �' A d e �658 LL'�1GTON'`,POAD
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Type Work LAT fYV :, f? .<W IYNORsrCT:`>06074
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Date Insp Needed " f?dtQ
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Time Insp Needed
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Inspected BY p ✓, :>: �;:::' � 3::`:,
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Permit No. 7823 Town of South Windsor, CT
Permit Date 09/23/2604 Drain Layer Permit
Expiration Date 10/23/2004 " ^
Descrip: 2 CHECKS # 13350 & 1334
Applicant «: >: o
/ /l f x
Name JMJ CONSTRUCTION .,. ��� 00 3# �gpmIS Rt3Ab
Addr. 658 ELLINGTON RODU
SOUTH WINDSOR a C"T 06074 ✓ f 3z
Phone No. (860)528-7589 lly ? z_ �lt_ gsy y
s rtt l= s � � £ i s_
The Drain Layer.,ass'ig ect:'" s peru?a:v!.,''7ryyp ' valid C" .Y4sp <is'v :ed by the
r state and hereby a4, o:ei. het'a :; i3.itic f r.sa3{t .forth in the
attached 'Condition '„r 3�1`Tgfi st �a :` if aaa >�: h"Tow of South
Windsor standards, a0 ;I . ., Y e ;a $ac d`"c&h.0itions.
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Issued By '"• n Ta i s 3 ---------------- 3
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Date Inspected
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