Loading...
HomeMy WebLinkAboutDrain Layers Permit 36 Loomis Road TOWN OF SOUTH WINDSOR INSPECTION REPORT Permit No. 7761 Contr;�•t`o'F"JACtYftS<. . NSTRUCTION (JOHN) .w Location fY' $ trt9t` I' :,> a Ad` rea, R,f G ;.d Type Work NEW SAN LAT k .FS „y S H T NI `k R, GI:;. 06074 �•`' Pilo e a�3 >t x j wild Date Insp Needed CA / sr a s ` � to Time Insp Needed j s ------------- Lg Inspected By ----------- Work in Progress e � 4 '�"Q_y_—PS`_�?c1L Y�—SL1S —'�Q ter '. _ _ . RV .3�.,r• In I i I 1 Permit No. 7761 Town of South Windsor, CT Permit Date 06/29/2004 Drain Layer Permit Expiration Date 07 2 Descrip: INST . ' Applicant L.. twtlon Name JACQUES CONSTRUCT< O rc%i7' >::.:s h":`•. Addr. 67 RIDGE ROAD CLARK T I i":,. `NC I . SOUTH WINDSOR Phone No. (860)432-18'' 11>: . M.. V. Yfl� The Drain Layer ss 'Ygr%. s ' r `s r ;'r : :d 1 ', ss. 0 d by the state and her `. t1 cn�t €'• <•:_"::% ` s hereby agr�a�s:t'tcty�%s�?F�he��`.�''r'mS'� '.' ��F� � �.�t4>'for in the attached 'Conditions .TlYl`tiyalf4Iti � Y {`' "' tsYari '' s:'wYt Tb n of South . s. ., ?. : Windsor standards, ali OSHA,y"`4•eia� 'TatG:�' eck: conditions. Issued B :.4 Y Date Inspected g -------------------- Ts --------- ---------------- 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: 3 Lot # Street No. 1' Street Name Name of Firm. Phone:. Address.of Firm: S 91 e' /,' TYPE OF WORK: Lay House Drain • Repair House Drain - Lay Main . ; Lay Lateral for Commercial/Industrial Building of acres Connection will be made with Existing Water Supply: Public Water . Well Proposed Start Date Estimated time for completion /6F ALL WORK-TO BE IN ACCORDANCE WITH•TOWN OF SOUTH WIN DSO147"ANDARDS, ALL OSHA REQUIREMENTS AND CONDITIONS ATTACHED TO THE PERMIT Permit is to be issued.to s o Guar fqc cto Q ,; holder of Drain Layer's License No. d Fig 3p O 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 Stroet Excavation Permit No. and/or ConnDOT Permit No. CBYD No. Signed: Print Name: 1it tiLa y S Licen ra' er Date: Y StandardY. \Perw(.n! LtCATtON FOR pRAiN LAYERS PERMIT doc TQWN OF SOUTH WINDSOR SANITARY ''SEWER LATERAL RELD LOCATION DATE O,F CONSTRUCTION: Q BUILDING ADDRESS - L - STREET S ► a SUBDIVISION: NORTH ARROW 1 t � t t Fi t f ' I ! y p ! t orz t i i t i { �� �- � - CONTRACTOR (PRINT) NAM OF CONTRACTOR'S SUPERVISO (PRINT) �,.3c _Q STREET ADDRESSIG LIRE S. 1� ` lr' (..` ©� C� 'n c DATE TOWN STATE ZIP_<_ _ INSPECTED BY-TOWN_- - - - - q 2''Q 2 , DATE TELEP NUMBER -- - _ WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER