HomeMy WebLinkAboutImported on 5/12/2009 at 8:23:00 PM 750058 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 10/04/07
GIS ID: 23500016
FEE: 60.00
MUNIS APPLICATION# 200701616 %T'-f """> >'° ":.: `
EXPIRATION DATE: 11/03/07
APPLICANT_ Y y>° LOCATION C TI ON
NAME: VMS CONSTRUCTIONt0MT?.:tNY. I 'Si ` r >C(JPIsR RIDGE
ADDRESS: 162 LAKE STREET :
>>t` ASK KELWO INC
VERNON ROCKVILL ` 0,66>;<";-y
4:E-11 GTON RD
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WIND SO T 7 C 06074
PHONE 860-871-02 : ;o� `,`,` .
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WORK DESCRIPTION: NEW SEV(?ESI '' "°
LOT 9 >>:...... : ...::
THE DRAIN LAYER ASSIGNED TO THIS P'RMIT`UAX't::: t L. .wL ::, S uED B�;'PHE S.T�4TE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORTS INIIII . ,`£TA k4I*S'.:_ ;k?V(7YK``SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDARsQS>A7; "b II'A'R .TT ..-4-1}3}T MAT-TACHED CONDITIONS.
ISSUED BY DATE` `°SPECTED PECTED BY
10/4/2007 9:26 AM
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO 775702-3,5
CONIRACTO
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LOCATION: I &Pfr-V_
TYPE OF WORK: :S4,,j/rA ,.-j
DATE INSP NEEDED: DATE INSP: IP ,g
INSPECTED BY:
WORK IN
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INPUT: DATE:
WJ2007 Town of South Windsor INPSECTION REPORT 07
APPLICATION FOR DRAIN LAYER PERMIT
qpr j-o aoo7ol6'16 TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $60.00
Location of proposed work: f)n- Lot # l
Street o. ftreet Name
Premises owned by:
Name of Firm: 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 Pv bL`a Sr
Existing Water Supply: Public Water_ Well
Proposed Start Date ba R o-7 Estimated time for completion 1 Dot y
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 yo c.T & M, SFR&MA.1A+ A. the holder of Drain
Layer's License No. Zg3 9 2 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. �—�
Signed: Print Name: -S-6et*ft91"
icensed Drain/Pdyer
--_-Standard-Forms\Permits\APPLICATION-FOR-DRAIN LAYERS-PERMrr.doc - ------ -- - - - — --
TOWN OF SOUTH WINDSOR
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CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPERVISOR (PRINT)
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STREET ADDRESS SIGNA RE
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TOWN STATE ZIP INS BY TOWN
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TELEPHONE NUMBER
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