HomeMy WebLinkAboutDrain Layers Permit 297 Pleasant Valley 750052 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 09/18/07 "€ >.:'
GIS ID:72900297 h< FEE: 60.00
MUNIS APPLICATION# 200701443 ��` • `rFr :;
EXPIRATION DATE: 10/18/07
T.. LOCAION
APPLICANT.:, �>.
NAME: WB DICKENSON `
E 'SANT VALLEY ROAD
: 7 PL .
ADDRE
SS: ' `. ER-.-... `
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NORMAN G
07SOUTH WINDSOR,
ST
T 06040
"CH
:.CHASTER,C
PHONE <.<
WORK DESCRIPTION: REPAIR LC7II . V ;';?Y `'
DRAIN LAYER ASSIGNED TO THIS TERMIT-;VT A.'VAITISEI `BX>T STATE AND HEREBY AGREES TO ALL
THE f .. :, .
THE TERMS AND CONDITIONS SET FORTH IrFiwATAk « 'h3; { I�IS' 'AI;;?V7IZI SHALL BE IN ACCORDANCE WITH
,THE TOWN OF SOUTH WINDSOR STAND ApS>'A L'{, A`. IT*1r 'ATTACHED CONDITIONS.
ISSUED BY DATE`TI FETED INSPECTED BY
9/18/2007 9:56 AM or
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.. CONTRACTOR:
LOCATION:
TYPE OF WORK:
DATE INSP NEEDED: DATE INSP: 9 ? /0
INSPECTED BY: 6A
WORK IN 1
PROGRESS: f �,. w �• g A b�J t�,t-�ea,
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INPUT:
DATE: ;7
W/2007 Town of South Windsor INPSECTION REPORT 07
• APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
O
1540 SULLIVAN AVENUE
�d
SOUTH WINDSOR, CT
FEE $60.00
Location of proposed work: 1?7 71
Lot #
Street No. Street Nam
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Premises owned by: ep-&,
7V
Name of Firm: 'G Phone:
Address of Firm:
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 d Estimated time for completion l
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 0-e�-yv�>Q the holder of Drain
Layer's License No./a- IeW7 20 . Only 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. o�O4? 00
Signed: L-.'� Name.� Print
Licensed Drain aver
—Date.,— -
Standard Forms\Permits\APPUCATION FOR DRAIN LAYERS PERM IT.doc
TOWN OF SOUTH ANDSOR
'SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS lc� ,rt-
STREET
SUBDIVISION: �---
NORTH ARROW
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CONTRACTOR (PRINT) T- NAME OF CONTRACTOR'S SUPERVISOR (PRINT)
STREET ADDRESS SIGNATURE
/7�o� DATE
N tTATE ZIP INSPECTED BY TOWN
DATE
TELEPHONE NUMBER
WHITE - TOWN PINK CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER