HomeMy WebLinkAboutDrain Layers Permit 5 Loomis Street i
TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 7637 Contra C"bor JAtQUES.;.,.CONSTRUCTION (JOHN)
Location 0005 LOOMIS ROAD Addre:Ss 67, FZIBGE R'O.AD
Type Work NEW SAN LAT SOUTH'°WII�DSOR'"CT 06074
Phon .No (4.60.)432-1823.,
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1 Permit No. 7637 Town of South Windsor, CT
Permit Date 05/28/2003 Drain Layer Permit
Expiration Date 06/27/2003
Descrip: CHECKS # 12406 12407
Applicant LQcat;ion
Name JACQUES CONSTRUCTION (JOHhT) Acidr. 00`05 LOOMIS ROAD__
Addr. 67 RIDGE ROAD Owner CLARK. 'REALTY INC`:,
SOUTH WINDSOR: CT 06074
Phone No. (860)432-1823 6
The Drain Layer, assigna C;h d is pimzt has �l v94sd e licnse issued by the
state and hereby agrees. to a1X the erm� and caAd:ij 0 s,'t==- forth in the
attached 'Conditions' All wb;rlt shad 7e ,>in accQxdance w "th own of South
Windsor standards, a'11 OS HA.requirem4fits,: and t;he attached conditions.
Issued BY - -- --------------------
Date Inspected Inspected By __---_---_-__________ ---
--------------------
APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $60.00
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S Leo r S P�q
Location of proposed work: Lot # 0 '
Street No. Street Name CPO
s�,�
Premises owned by.--
Name of Firm: J-A-r62 L'g
Phone:
Address.of Firm:
TYPE OF WORK:
Lay House Drain X , Repair House Drain
Lay Main ; Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with
Existing Water Supply: Public Water—)(:-,Z Well
Proposed Start Date S stimated time for completion c3 o
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 CAS 11041oc. the holder of Drain
Layer's License No. 24 8 8 S ce . 0 y 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_VX c . rc?"�e S
Licensed ai ay
Date: Q
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMrr.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION:
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CONTRACTOR (PRINT) NAME OF CONTRACTOR'S S RVISOR (PRINT)
STREET ADDRESS f SIGNATURE �J
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DATE
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DATE
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WHITE — TOWN PINK — CONTRACTOR YELLOW — CONSULTING ENGINEER / DEVELOPER