HomeMy WebLinkAboutDrain Layers Permit 976 Pleasant Valley 750068 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 10/11/07
GIS ID: 72900976
MUNIS APPLIC FEE: .00
ATION# 200701672 � '�' �;;��
EXPIRATION DATE:
11/10/07
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NAME:
JAMES :.
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S y `".97,PIXA$ANT VALLEY ROAD
ADDRESS: 97 RIVERSIDE DRIVE:'
LLC: :... .:......
VERNON ROCKVILL ` 'I
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, 06074PHONE 860-289Q0:WO
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CRIPTION:
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THE DRAIN LAYER ASSIGNED TOT "'HIS PI~RMIT' A t .: ,t1I SUE�'�y,-T STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORTS III;> I ::iTp �jI;JS�`.> SHALL BE
THE TOWN OF SOUTH WINDSOR STANDAl �'A�"10.8K!'. :.;:,:'`:. ' " ,,: IN ACCORDANCE WITH
'•�, 1ND TEI .ATE ACHED CONDITIONS.
ISSUED
BY VA E S°PE'C'TED INSPECTED BY
10/11/2007 11:54 AM
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.:� CONTRACTOR: `)a
LOCATION:_ �1, -I/„ J j '.
TYPE OF WORK:_
DATE INSP NEEDED: DATE INSP: 40
INSPECTED BY: r7p
WORK INr
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PROGRESS:_ or
AS-BUILT:
INPUT:_ DATE:_ ,p a,q 0
W/2007 Town of South Windsor INPSEMON REPORT 07
APPLICATION FOR DRAIN LAYER PERMIT
cc�P� o2pD70/67a TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $60.00
Location of proposed work: 976 -KAL P-,-d. Lot #
Street No. Street Nime
Premises owned by: G' �OAC
Name of Firm: VS S � Phone:
Address of Firm: 9 7 Riueii i
TYPE OF WORK:
Lay House Drain_; Repair House Drain ;
Lay Main ; Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with S p e 3 6'
Existing Water Supply: Public Water_ y + Well
Proposed Start Date LUnL(2-07 Estimated time for completion 3 0L
ALL WORK TO BE IN ACCORDANCE WITH TOWN OF SOUTH WINDSOR STANDARDS,
ALL OSHA REQUIREMENTS AND COND ONS ATTACHED TO THE PERMIT
Permit is to be issued to the holder of Drain
Layer's License No. U 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 at ched thereto. Applicant has received
Town Street Excavation Permit No. Allk and/or ConnDOT Permit No.
CBYD No. Z C.O74100 Z 5jS6
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Signed: Print Name: Y�,�S
Licensed Drain Layer
Date: 9(JG�0-7
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD , LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS 9 7Z 97oO
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CONTRACTOR (PRINT) NAME 0 CO TOR'S SU SOR NT)
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STREET ADDRESS SIG RE
DATE
TOWN STATE STATE ZIP INSPECTED BY TOWN
1 D 6? DATE
TELEPHONE NUMBER
'� — TOWN PINK — CONTRACTOR YELLOW — CONSULTING ENGINEER / DEVELOPER