HomeMy WebLinkAboutDrain Layers Permit 16 Copper Ridge (2) 750058 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE 10/04/07
GIS ID: 23500016
:,v<.<;;:.MUNIS APPLICATION# 200701 FEE: 60.00
616 fit' I; EXPIRATION DATE:
11/03/07
APPLICANT
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NAME: VMS CONSTRUCTION,tomp NY...< ' �I I 'S ". 'j CQPP RIDGE
ADDRESS: 162 LAKE STREET '
-KELficO INC
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VERNON ROCKVIL
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INGTON RD
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E1T WIND
PHONE
860-8 - .2
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WORK DESCRIPTION: NEW SE .� ET `
LOT 9
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HE DRAIN LAYER ASSIGNED TO THISRMI IIA .[ . AL S�1I�I ^` H
fir,: HE. ...... . S.TtTE AND HEREBY AGREES TO ALL
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THE SS AND CONDITIONS SET FORTS INHT : ;W(RK`SHALL BE IN ACCORDANCE WITH
TOWNTHE OF SOUTH WINDSOR STANDATDS{'AI pHA11`iT ,ANj THI;..�iACHED CONDITIONS.
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ISSUED BY DATA" 'S'PECM PECTED BY
10/4/2007 9:26 AM
or
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: _757�-VSS CONTRACTOR:_
LOCATION:_(� ��PQG�-- �QCX_
TYPE OF WORK: :S4-,,Jir Aaf SAW,,' eZ C� n�GC�rl9•.1
DATE INSP NEEDED: DATE INSP: I s-7
INSPECTED BY:
WORK IN
PROGRESS: Qt (� f j-j II T-n �/�s-r�•�L
AS-BUILT.
INPUT: DATE:
W/2007 Town of South Windsor INPSEMON REPORT 07
75o 0S 8
APPLICATION FOR DRAIN LAYER PERMIT
aPPj a0o�o�E�6 TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $60.00
Location of proposed work: Lot # I
Street fireet Name
Premises owned by: S��
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
Existing Water Supply: Public Water, Well
Proposed Start Date I'n 9 o? Estimated time for completion 1 Dot
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 V1 C-Ta M, S A,,&� the holder of Drain
Layer's License No. ZF3 9 2 . Only hol ers of P-11 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:_ rI, - Fl J
icensed Drain/W lye
Date: 0
Standard-Forms\Permits\APPUCATIONfoR DRAIN LAYERS PERMIT..doc — —
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION:
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BUILDING ADDRESS (67-_* ?�
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SUBDIVISION:
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CONTRACTOR (PRINT). NAME OF CONTRACTOR'S SUPERVISOR ( NT);
STREET ADDRESS SIGMA RE
IOe°e^' GT 06C66 DATE-
TOWN STATE ZIP INS . BY TOWN
TELEPHONE NUMBER
.WHITE - TOWN
PINK CONTRACTOR YELLOW - CONSIjLTING ENGINEER / DEVELOPER
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