HomeMy WebLinkAboutDrain Layers Permit 80 Edgewood Drive 750053 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER
DRAIN LAYER PERMIT
DATE: 09/24/07 s °>_ y
GIS ID:29400080
MS APPLIC
ATION# 200701504 ^' ,, u> . FEE:
60.00
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RATION DATE:
.; 10/24/07
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NAME: LOCATION
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ADDRESS: 97 RI ..., :>' 0. DGEWOOD DRIVE
RIVERSIDE DRIV
VERNON ROCKVILIJE
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V�OOD DRIVE
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PHONE {._.°ri :< '`<yy H..I
860-289-d0: ;: >wti `'' IIDSOR,CT 06074
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THE .:: ,
DRAIN LAYER ASSIGNED TO THIS AE `A�';'
THE TERMS AND CONDITIONS SET FORTS IN 'HR=:AT B TIfiE,SATE AND HEREBY AGREES TO ALL
THE TOWN OF SOUTH WINDSOR STANDA <'::� Q SHALL BE IN ACCORDANCE WITH
N I ,<�13`1I:,; HE A'I TACHED CONDITIONS.
ISSUED BY
DATE 11�WTED INSPECTED BY
9/24/2007 8:17 AM
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMITNO.: CONTRACTOR:
LOCATION:
TYPE OF WORK:
DATE INSP NEEDED: DATE INSP: a 7 o
INSPECTED BY: f3D
WORK IN
PROGRESS:_
IS
OVA
AS-BUILT: V
INPUT: DATE:
W/2007 Town of South Windsor INPSECTION REPORT 07
APPLICATION FOR DRAIN LAYER PERMIT
q l 0�00�0/S4y TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $60.00
Location of proposed work: d �'r Lot #
Street No. Street Name
Premises owned by: /'iT J, � Sw,,, l
Name of Firm: V v� Phone: 2V�
Address of Firm: S 7 ea, ® O/c Lltrvior-�
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.X, Well
Proposed Start Date Estimated time for completion 0-7
ALL WORK TO BE IN ACCORDANCE WITH TOWN OF SOUTH WINDSOR STANDARDS,
ALL OSHA REQUIREMENTS AND COND ONS ATTACHED TO THE PERMIT
Permit is to be issued to the holder of Drain
Layer's License No. J6 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. <)7 3�c5 / 2z
Signed: Print Name: Jfks_A��
Licensed Drain Layer
Date:
standard Forms\Permits\APPLICATION FOR-DRAIN LAYERS PERMIT.doc -
y.y TOWN OF SOUTH ANDSOR
SANITARY SEWER LATERAL FIELD - LOCATION
DATE OF CONSTRUCTION: c?7
BUILDING ADDRESS
STREET
SUBDIVISION:
NORTH ARROW
. 14
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CONTRACTOR (PRINT) _T— NAME F CONTRAC 'S SUPERVISOR (PRINT)
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STREET ADDRESS SIG RE
TOWN STATE ZIP INSPECTED BY TOWN
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TELEPHONE NUMBER
\ WHITE - TOWN PINK CONTRACTOR YELLOW CONSULTING ENGINEER / DEVELOPER