HomeMy WebLinkAboutDrain Layers Permit 23 Maple Street (2) TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No Contractor SKIPS SEPTIC
Location Address 27 MUDDY BROOK ROAD
Type Work NEW SAN LAT ELLINGTON CT 06029
Phone No. (860)875-2332
Date I nsp Needed ® Date, I hsp
Time Insp Needed Time-'Insp',
Inspected By
Work in Progress % �/41
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Input Date
Permit No. * .;, - - 3139 Town of South Windsor , CT
Date 06/28/2001 Street Excavation Permit
Expiration Date 06/28/2002
Descrip: NO FEES TOWN JOB SEE WPCA APVL 06/05/01
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Applicant Location
Name SKIPS SEPTIC 0023 MAPLE STREET
Addr. _27 MUDDY BROOK ROAD
ELLINGTON CT06029ypes, Work" NEW SAN LAT
Phone (860)875-2332
fur s
Applicant agrees to .-ruh the 'Qwn : f Sbuth :Windsor the amount of bond
required and to reimburse 1Fie town'oi; South "Win"dent %for any expenses
incurred by the Town for ma nt,Ona6oe "off repair W,6rk in connection with this
permit and that app l i 0ant . ,,fame I a an wl, 1.1. abide de by the rules and
regulations for permi ins` as u l_ n i 0 ,�.,Town-Of f South Windsor's Street
Cut Permit Manual .
* * PERMIT T ',-AE KEPT QN, J08 SITS AT ALL TIMES.
Issued bye /"---r' T ► ® %`gym �'=�
� S� �'�
Date Completed Y' / inspected By
APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, a
FEE $25.00
Location of proposed work: o? 3 /# S 7— Lot #
Street No. Street Name
Premises owned by: J Ilk K£P"7tT
Name of Firm: Sk B PS lyf-P77 C Phone: 3 7 S 2 3 3 2
Address of Firm: 2g M."Wq �,T.Q00% 9 CJ-L rAa 67b
TYPE OF WORK:
Lay House Drain X ; Repair House Drain ;
Lay Main ; Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with 7 VG
Existing Water Supply: Public Water Well X
Proposed Start Date 3-0 1 Estimated time for completion r7- 6-o I
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 -rdl% tukk £-X- the holder of Drain
Layer's License No. . Only 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. 00 0
Signe Print Name:
License rain Layer
Date: a 2- '—o j
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc
y r .
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSORf CT
FEE $25.00
Name of Firm (5*1PS NSF P77C Phone No. 8?S z 3 3 a-
Address of Firm 27 M u D Dv �B200 K 212> qJ-L 1,U6 rn nl
Location of proposed work 2.3 MHPILE Sr a,
Describe fully nature of permit requested C u r I ti ro 7Z a�6 4` w (D ec- -M nW I afro g r'
j)yr- SFweat.
Starting date r!-3- 01 Approx.time for completion 17- 3 , o i
Call Before You Dig No. 2 o 6 r z G o I Ce 0 9 Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North Prop.size of cut
Z3 No.cuts
_f
'Amt.of Deposit$ d:!j: by
()Cash(.)Check* )alp
` Cut size after Perm. Patch kIRCIA
11° No. Cuts
® Final Billing$
Amt.Due Payee$
Amt Due Town$
Applicant is responsible for contacting by date _
the Police Dept,and C.B.Y.D.
I AGREE TO FURNISH TO THE TOWN OF SOUTH WINDSOR THE AMOUNT OF BOND REQUIRED AND TO REIMBURSE THE TOWN OF
SOUTH WINDSOR FOR ANY EXPENSES INCURRED BY THE TOWN FOR MAINTENANCE OR REPAIR WORK IN CONNECTION WITH THIS
PERMIT AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR PERMITS AS OUTLINED IN THE
TOWN OF SOUTH WINDSORS STREET CUT PERMIT MANUAL.
Signed: Date: �- z $'-o I
Title:. �� S D.L*:
PERMIT SHALL BE KEPT ON]OBSITE AT ALL TIMES
Standard Forms\Permits\Street ExcavaUo t PermiLdoc