HomeMy WebLinkAboutDrain Layers Permit 175 Diane Drive 750070 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER
k. DRAIN LAYER PERMIT
DATE: 10/15/07
GIS ID:28200175
MUNIS APPLICATION# 200701687 ` FEE: 60.00
f' _X;:
l`"'' EXPIRATIO
N DATE:
11/14/07
APP
LICANT::::
I C A NT:::�
NAME: VIOLETTE SILVESTER&.§� : "`:"`;'': '€' "Y' .
DRESS lS IbIAN DRIVE
ADDRESS: 65 CHERRY STREET < � RICrVEIR;E)DO JO-ANN M&ELIDIO M
EAST HARTFORD,CT 05:1`0 •:: :''
)RIVE
WINDS
OR,CT 60
PHO
NE 74
860-2894465"
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RK
RK DE
SCRIPTION:
S C RIP TI O N:
NEW
SE
THE DRAIN LAYER ASSIGNED TO THIS,:..I?ERMIT 1A .A
VA
' ] ` ZSST7ET�,$'Y T SATE AND
THE TERMS AND CONDITIONS SET FOR a:,....,.....':. .: HEREBY AGREES TO ALL
T I : IE''.4TA9? � 5 • L WORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDAl ';ALL O TI'A'R1II " hNl�`1HE`A°"ITACHED CONDITIONS.
ISSUED BY DATE'M TED
10/15/2007 9:51 AM INSPECTE BY
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: CONTRACTOR:
LOCATION:
TYPE OF WORK:
-------------
DATE INSP NEEDED: DATE INSP: 10 I&A
INSPECTED BY:_ �_____
WORK IN
PROGRESS: �wi �,� sd d '` v�• �rz 3 F�
F�J� cst rrp u.n c�-ca! %..� 3�51t � Cd •.s�,.�� �-..� � � ��Sl ,�_ -,_.— T
T
AS-BUILT:_
INPUT: C Y � DATE:_
W/2007 Town of South Windsor INPSEMON REPORT 07
P,erm,-f 4 7SOG70
APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
4��/ a0o70/687 PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $60.00
Location of proposed work: Lot #
Street No. Street Name
Premises owned by: J 0 � v�r i r c do
Name of Firm: Phone:
Address of Firm:- SC�r�v'h� �T Q� a 10 CL
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 n/SD 7 Estimated time for completion a
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 — f 1" the holder of Drain
Layer's License No. ?��'9 4 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. --�C) 07 -/ l O n�03
Signed: Print Name: C��S'� � ��
icensed Drain Layer
Date: /O -/S-2C')0'7
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc
TOWN OF SOUTH ANDSOR
SANITARY SEVER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: A9 �`� ° ® 7
BUILDING ADDRESS
STREET :
SUBDIVISION.-
NORTH ARROW
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CONTRACTOR (PRINT) NAME OF C NTRACTOR'S SUPERVISOR (PRINT)
STREET ADDRESS f SI RE
Lad y f f—c� CT- vet 1o?— ! i cc DATE
TOWN STATE ZIP INSPECTED BY TOWN
DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER