HomeMy WebLinkAboutDrain Layers Permit 128 Loomis Road TOWN OF SOUTH WINDSOR INSPECTION REPORT
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Permit No. 7248 Contractor JACQUES CONSTRUCTION (JOHN)
Location 0128 LOOMIS ROAD Address 67 RIDGE ROAD
Type Work NEW SAN LAT SOUTH WINDSOR CT 06074
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Phone' No. (860)432-1823
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Date Insp Needed �4c, �° � pate Ihsp-. DV/0'� D�
Time Insp Needed Time In$P1 ralliv
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Inspected By
Work in Progress
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Input Date
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P Nero=,f 7248 Town of South Windsor, CT
Per-mi t "tea_' 03/21/2001 Drain Layer Permit
Expiration-Date 04/20/2001 I
Des6rip: CK10608 775. 00 CK10609 49 . 97
Applicant Location
Name JACQUES CONSTRUCTION (€S`OF N;i _Ad'd ",: 0128 LOOMI S ROAD
Addr. 67 RIDGE ROAD twner. €LAR1t REALTY INC
SOUTH WINDSOR CTY06074,
Phone No. (860)432-1823 �,'
The D.rai n Layer assi`�g66+0 this ;perm_ji� has � ��� 7 d 'license issued by the
state and hereby agrees ts� "a !.# the "ter�€t� and cond,i Ti olns set forth in the
attached 'Conditions ' =+41 rk, h �i !fie is n acc r,da' nce with Town of South
Windsor standards, ail _QSHI '. gU"irem®tits;. and "thy :attached conditions.
Issued By
Date Inspected �� d; ' in"edted
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TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: n f . �-
BUILDING ADDRESS c f-
STREET : �� S` L-0 D
SUBDIVISION: N► � � l
NORTH ARROW
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CONTRACTOR (PRINT) NAME F CONTRACTOR'S ZPERVISOR (PRINT)
., STTREET ADDRESS SIGNATURE
JS vr� �/ �� 77 � p y p p� DATE
TOWN _ STATE
g ZIP INSPECTED BY TOWN -� T
h Q �l .�- (.' o� (j DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER
7Z
APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Location of proposed work: Lot #
Street No. Street Name
Premises owned by: J
Name of Firm: Phone:
Address,of Firm: JC g O Ad S
TYPE OF WORK:
Lay House Drai Repair House Drain ;
Lay Main; Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with S 3 S
e
Existing Water Supply: Public Water Well
Proposed Start Date L 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 issue Cct J d to . the holder of Drain
Layer's License No. d
. 0 y holders of P1 or P7 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: -7o4h � liGZc>�S
Licens r ' ayer
Date: �/ D
Standard Forms\Permits\APPLICA'n0N FOR DRAIN LAYERS PERMIT.doc