HomeMy WebLinkAboutDrain Layers Permit 24 Copper Ridge 750059
PERMIT NUMBER TOWN OF SOUTH W I N D S O R, CT
DRAIN LAYER PERMIT
DATE: 10/04/07
GIS ID:
23500024
MUNIS APPLICATIONEXPI`
FEE:
• 60.00
RATION DA
TE:
1 1 0 3 0 7
A P P
C A NT :
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ADDRESS: 1 ' 1�1Y....:::::> I
62 LAKE STREE < ' ISS;` ,CQPP RIDGE
VERNON ROCKVILLI -KELLCO INC
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SCRIPTION:
S C RI N: W
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P T O
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THE
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AIN IN LA
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ASSIGNED
xa••>�.T :�>,
THE TERMS THIS RMIT'"A A, A ;:V""ti: ; ... '.
AND CONDITIONS SET FOR " >. : `$>....:.
T IN> STATE TIC:'' AND HEREBY AGREES TO ALL
THE TOWN OF SOUTH WINDSOR STANDAID ::"'T�x : 5'4'` Z< SHALL BE IN ACCORDANCE
' I � Ic WORK
CONDITIONS. NCE WITH
ISS ED BY %fiw*
10/4/2007 9:40 AM DAT SFB'CTED' SPECTED BY
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: '75b- 05—') CONTRACTOR:_ V/MS
-. LOCATION:_ 4 CoPPIF- ��[P&Ei
TYPE OF WORK:_ `5euJT'AfLL,( r-,
DATE INSP NEEDED: DATE INSP: L,� �j
INSPECTED BY: JJP
WORK IN
PROGRESS:_ P6-
AS-BUI LT.
_t/—
INPUT: DATE: z? a D
W/2007 Town of South Windsor INPSECTION REPORT 07
75 a 051
APPLICATION FOR DRAIN LAYER PERMIT
' TOWN OF SOUTH WINDSOR
0070/G/`� PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $60.00
Location of proposed workaY -e-r RIt4s-e— Lot # O
Street Tqb. ttreet Name
Premises owned by: Esk—
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 �� )�`c �'�,. .S�w er-
Existing Water Supply: Public Water. Well
Proposed Start Date 1 b Z147 Estimated time for completion D 7'
ALL WORK TO BE IN ACCORDANCE WITH TOWN OF SOUTH WINDSO'R STANDARDS,
ALL OSHA REQUIREMENTS AND CONDITIONS ATTACHED TO THE PERMIT
Permit is to be issued to Vlcrc m, C* the holder of Drain
Layer's License No. _2-V3 Only hold rs 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. Z4U7�iD I jfl
Signed: , --./- Print Name: lc--r-�r- fig- kAm 4j,
icensed Drain er
Date: _ a0VO:7
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc
TOWN OF SOUTH WINDSOR
" ' SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: 10 Vo-7
BUILDING ADDRESS : 2-Y C-o f 0EA-- AP64- L(07--A- ,�s
STREET
SUBDIVISION:
NORTH ARROW
3 1M
- -
1 f
_ , 1 a
Vi c—rsp, m �mAm gw,+ It
CONTRACTOR (PRINT). NAME F CONTRACTOR'S SUPERVISOR (PRINT)
STREET ADDRESS SIGNA t
DATE
�49 C-7
TOWN STATE ZIP INSP BY TOWN
a-8�r- oZ�g DATE
TELEPHONE`NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW — CONSULTING ENGINEER / DEVELOPER