HomeMy WebLinkAboutDrain Layers Permit 473 Sullivan Avenue 750077 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 10/29/07 ,;,
GIS ID: 87300473 r +v FEE:
., 60.00
MUNIS APPLICATION# 200701770' EXPIRATION DATE: 11/28/07
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APPLICANT > } y
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NAME: ENVIRONMENTAL SE VTC S <• v: DDRES F;." �#13 SI L tUAN AVENUE
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ADDRESS: 90 BROOKFEILD STRE.T;:. z :SAS>.:::.: t:, ;ER: :..:c..,<fAY. L SCAPINLLC
SOUTH W :.:; t,...r; f..;'..; ;
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WIPTDSO CT 06074
PHONE 860-528-9$00 >»1 .f`>'••
WORK DESCRIPTION: NEW SEVI ' AsI' � '
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THE DRAIN
LAYER ASSIGNED TO THIS I RMIT STATE S, A`I'E AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORA IN,
31VORI{'SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STAND AR S;A bS A E I 54THL"°AT, CHED CONDITIONS.
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IS SUE15 BY DATE E; +ED, ; INSPECTED BY
10/29/2007 11:45 AM
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: 00 -7 _
-- CONTRACTOR: c�n
LOCATION:
TYPE OF WORK: YA
a 'S
DATE INSP NEEDED:
INSPECTED BY: DATE INSP:
WORK IN
PROGRESS: ..........
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AS-BUILT:
INPUT: J
DATE. �J , 6
W/2007 Town of South Windsor INPSEMON REPORT 07
Per m, 7SOO77
�. APPLICATION FOR DRAIN LAYER PERMIT
a pp add 7Ol 220 TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE '4St' 4/ G4/at11,11C,
SOUTH WINDSOR, CT .�'�� =.3, Vd-
FEE $60.00
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Location of proposed work:_ «(/► ►�4V
Street No. Street Name
Premises owned by: - J A
Name of Firm: (5,.j y !r�,N,,r� .Phone:
Address.of Firm:_ 0 oR-60
TYPE OF WORK:
La House Drain
rain
Repair House Drain .
Lay Main Lay Lateral-for Commerdal/Industrial
Building of- acres
Connection will be made with _ 'f PLC
Existing Water Supply: Public Water ✓
. - Well .
Proposed Start Date ��� Estimated time for completion �v a �•
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ALL WORK TO BE IN ACCORDANCE WITH TOWN OF SOUTH WIND ST DARDS,
ALL OSHA REQUIREMENTS AND CONDITIONS ATTACHED TO THE PERMIT
Permit-is to be issued to n'I kv, Cu C d th older of Drain
Layer's License No. aa7�5 4 On y holders of P-1, - or W-9 licenses
will be issued.a permit. PERMIT WILL EXPIRE THIRTY(30 AYS 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 Pen�nit No. and/or ConnDOT Permit No.
on j !� a—
CEYD No.
Signed: Print Name:- i c,4P) u �sI
Lic ain Layer
Date:_to al c d
Standard Forms\Permits\APPLiCAj10N FOR DRAIN LAYERS PERMIT.doc
TOWN -OF -SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: 0�
BUILDING ADDRESS : Y'27
STREET : So C L) AL)
SUBDIVISION:
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CONTRACTOR (PRINT) NME�,F CO CT 'S SUPERVISOR (PRINT)
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STREET ADDRESS SIGNATUR
0 A,;D c—� v CAI;o � Ir� '7 DATE
TOWN STATE (� ZIP INSPECTED BY TOWN
A-0 a DATE
TELEPHONE NUMRER
WHITE TOWN PINK -`CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER