HomeMy WebLinkAboutDrain Layers Permit 200 Maskel Road 750062 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER
DRAIN LAYER PERMIT
DATE: 10/09/07 `A' °
GIS ID: 57900200
FEE
• 60.00
MUNIS APPLICATION# 200701651
XPI E RA TIO NDA
TE:
11/0 8/07
�Fy
�.n
APPLICANT
,.> `LOCATION
NAME: EAGLE EARTHWORK-
'::'r` ::,,.:.:
¢.MAELROAD
ADDRESS: 101 N MOU
NTAIN RO r'<r
A1
... k% �1I`:r1T10 BUILDERS INC
CANTON CT 0601
RD' #3-F
9
yY 1�VLS CT 06 074
PH
ONE
NE
860-6 3-9 �02 2 7"
,.0
l'
WO
RK
RK DES
CRIPTION:
RIP TIO N: INST AL <s
:ERA;L
:� .t..
TH
E DRAI
N LAYER
ASSIGNED TO THIS PERM..':�I�^..•5:A� 7>'�x'' ; ''.':Vas:..� �,,....,. N�� ISSUF,,�3`I�1',,TH�`S�'ATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORTIS INrflI ATTY ; IC dS':""AF L' Q} SHALL BE IN ACCORDANCE WIT
H
THE TOWN OF SOUTH WINDSOR STANDARI � iL f 0STi1;:Q` I MiI 'ANn;TH1r:ATTACHED CONDITIONS.
ISSUED BY DAT INSPECTED INSPECTED BY
10/9/2007 4:39 PM
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: CONTRACTOR:
LOCATION:
TYPE OF WORK:
DATE INSP NEEDED: DATE INSP: �//o/07
INSPECTED BY: LSD
WORK IN
PROGRESS:_ C ill- Die 3s Fr" st,u
�in rl�i�Slrl/Lld `,�, 3/ nr �i�r t,s l�-t,c� �"'�-✓L� Suva.
AS-BUILT:
INPUT: Cam" DATE:_
W/2007 Town of South Windsor INPSECTION REPORT 07
AequcATi,.j A4 ,yfl�651
APPLICATION FOR DRAIN LAYER PERMIT 64,ra #
TOWN OF SOUTH WINDSOR 4.99t,
PUBLIC WORKS DEPARTMENT
TOWN HALL vr:'� 0 1$0°O,
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $60.00
Location of proposed work: 200 1�G.5 e I �G .Lot #-_
Street No. Street Name
Premises owned by: I' 411440mk14 �y;U&I
Name of Firm: Phone: 0X7
Address of FirmJ 0( V n�f-� 6V a fat�9 U- (,Gc tlliAML
TYPE OF WORK:
Lay House Drain K ; Repair House Drain ;
Lay Main ; Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with �G
Existing Water Supply: Public Water Well
Proposed Start Date G h' lD Estimated time for completion
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 Pv �t' "y r leov- the holder of Drain
Layer's License No. 2,7 On to . 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:MJ� &PokPrint Name:
Licensed Drain Layer
Dater
Standard forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc aGl1L ry,
TOWN OF SOUTH WINDSOR
SANITARY, SEALER LATERAL FIELD., LOCATION
DATE OF CONSTRUCTION: 1610 e ,7
J r
BUILDING ADDRESS : CMG'
STREET : rL� �
SUBDIVISION: -K1
NORTH ARROW
...... ...._._ .. ice... .»«. .� �.„„...�... �. ..,�
a {
i I t 3 it
_j
4-1
L _E
CONTRA* OR (PRINT) NAME OF CONTRACTOR'S SUPERVISOR (PRINT)
STREET ADDRESS SIGNATWE
cad �� � '� 101111107 DATE
TOWN STATE ZIP INSPECTED BY TOWN
DATE
TELEPHONE NUMBER'
WHITE -- TOWN PINK CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER