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HomeMy WebLinkAboutDrain Layers Permit 24 Loomis Road Or TOWN OF SOUTH WINDSOR INSPECTION REPORT P Permit No. 7673 Cont:r'actor, JACQUES""CONSTRUCTION (JOHN) Location 0024 LOOMIS ROAD Addres '` .67 13DC3'E ROAD.:;_ Type Work NEW SAN LAT ..... aU x WINib$OY2 CT., 06074 hone . No (8.6 ')432 .T:$23 Date Insp Needed Date Insp '� Time Insp Needed Time Is),S� Inspected By j .,.. t � Work in Progress _l_bv� � ✓ /5 � `' iy. t t (�6 4S i r. Permit No. 7673 Town of South Windsor, CT { Permit Date 09/25/2003 Drain Layer Permit Expiration Date 10/25/2003 Descrip: USER FEE PAID-CK#126i1 ., Applicant Loeati:.Qn i Name JACQUES CONSTRUC IONfJOIN) d.d:x. 0U.24 LOOMIS RQAD Addr. 67 RIDGE ROAD Qwix: ...,CLARKALTY INC SOUTH WINDSOR CT 06074 Phone No. (860)432-1&23 ? a The Drain Layer .4ssigrrerl -thijs pert it has a va �d- ki.cense'issued by the state and hereby agrees .to ell. he terms and corid�t3ors set<::forah in the attached 'Conditions' . All work shill" be 3 eordaace,With Town of South Windsor standards, af1.. OS A recjuir inents : '.anti the at aChgd Conditions. ) Issued By 'Title Date Inspected ______ Inspected By _ `76 , 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: Lot # 0 Street No. Street Name Premises owned by: J 60t�'? Name of Firm: _ Phone: 8'a"©C Address.of Firm: TYPE OF WORK: Lay House Drain Repair House Drain Lay Main ; Lay Lateraf for Commercial/Industrial Building of acres Connection will be made with S S— Existing Water Supply: Public Water Well Proposed Start Date S— Estimated time for completion ALL WORK TO BE IN ACCO DANCE WITH TOWN OF SOUTH WINDSOR STANDARDS, ALL OSHA REQUIREMENTS AND CONDITIONS ATTACHED TO THE PERMIT Permit is to be issued to je ✓the holder of Drain Layer's License No. © WaD finly 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:_ JG-&a c>w—� ��Lfin D Layer Date: 0 3 ' Standard/orms\Pe/rm- WPLICATION FOR DRAIN LAYERS PERMIT.doc TOWN OF SOUTH WINDSOR ' SANITARY SEWER LATERAL FIELD LOCATION DATE OF--.-CONSTRUCTION: J BUILDING ADDRESS L o r_ STREET o SUBDIVISION: �'``v` ,�) IStti� NORTH ARROW I ! _ i t 1 , . • I I { , t = E k _ I ��� I + I t CONTRACTOR (PRINT) NAME F CONTRACTOR' SUPERV OR (PRINT) STREET ADDRESS SIGNATURE ice/ S�✓ T 0 � 6 V DATE TOWN STATE ZIP INSPECTED BY TOWN _- ,-0 DATE TELEPHONE NUMBER WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER