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HomeMy WebLinkAboutDrain Layers Permit Maskel Road 750025 TOWN OF SOUTH WINDSOR, CT PERMIT NUMBER DRAIN LAYER PERMIT DATE: 07/10/07 ":: ii GIS ID: 57909999 FEE: 60.00 # 200701051 "` "' EXPIRATION DATE: 08/09/07 MUNIS APPLICATION '` `' N rri< ATIO APP LICAN T O lk�TsL`<ROAD NAME: SIMSCROFT ECHO FAIiM's's`. ..-....<.... YN OF`SOUTH WINDSOR ADDRESS: P O BOX 581 . y.:. fj::,^ MSBURY CT 06070;i' IFL �a.a IIN AN AVE '3... o....,: CT 06 07 4 H'WII�TDSO PHO NE E 8 60 651-a I > >�::>,,^;..• .WORK DESCRIPTION: EXTENSIQN`Q -.� N I � S $DVSTN.,is F � ::.N<' T PART OF kIL THE DRAIN LAYER ASSIGNED TO THIS�RMIT`tL'S :,VAL1 `ati3 7 'x':;1H STATE AND HEREBY AGREES TO ALL ,:: THE TERMS AND CONDITIONS SET FORTk IN:Ttl ,A'-TAE'l I N.S'. > L VCSRT SHALL BE IN ACCORDANCE WITH THE TOWN OF SOUTH WINDSOR STANDAIWS,`AIsL',(JS'HA°ICr:�E I :: TACHED CONDITIONS. ISSUED BY DATSINS ',- INSPECTED BY 7/10/2007 9:20 AM TOWN OF SOUTH WINDSOR INSPECTION REPORT PERMIT NO.:_ 1,0 a z CONTRACTOR: LOCATION: (Vta ADDRESS: s' TYPE OF WORK: 441 S)r,L DATE INSP NEEDED: DATE INSP: i� n INSPECTED BY: a WORK IN PROGRESS:_ ScL,,�cam- /" r c j ��`.�.,� J S T Gii✓1 < r INPUT: DATE: APPLICATION FOR DRAIN LAYER PERMIT -GPJ # ao�7©l05 TOWN OF SOUTH WINDSOR PUBLIC WORKS DEPARTMENT TOWN HALL 1540 SULLIVAN AVENUE SOUTH WINDSOR, CT FEE $60.00 Location of proposed work: kvA RA -Lot # Street No. Street Name Premises owned by: �dw�, � C , Name of Firm: '::�t Ms-Lrz CD _grM 4;:Z Phone: Address of Firm: oZ Revj TYPE OF WORK: � �S/Gn o IM ff Rot .se k ep n`h �l p rbd v h,1 / L-fss� Lay House Drain ; Repair House Drain Lay MainX _ ; Lay Lateral for Commercial/Ind'ustrial Z Building of acres Connection will be made with Existing Water Supply: Public Water Well Proposed Start Date 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 the holder of Drain Layer's License No. . 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. .2eo: _aGooe 7C4 j r�, 0 � • 20 s' V �0 Signed: Print Name: Licensed Drai yer Dater d � Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc