HomeMy WebLinkAboutDrain Layers Permit 201-202 Wentworth Pa TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 7929 csntr to J W„:H SLkf$.R CONST CO
Location 201/202 WENTWORTH PARK Address 75 COMdiEI; E NfAX
Type Work NEW SAN LAT3UTH b1.INIhSOR CT.,06074
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Permit No. 7929 Town of South Windsor, CT
Permit Date 06/14/2005 Drain Layer Permit
Expiration Date 07/14/2005
Descrip: INSTALL SEWER LATERAL..<.
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Applicant p
li cant
Name J & H SLATER CONS P GO pYfi} 2,Q:j/ QZ. .WENfiV�d12TI3 PARK
Addr. 75 COMMERCE WAY. CYWnr.;GENER:A7I:0N.2
SOUTH WINDSOR CT. (76Q74:.=
Phone No. (860)528-5.25
The Drain Layer .ass3g c this Z zmat I3a ld 1 eense' issued by the
state and hereby agret „to,.2 :. ""'L,.;theter ms and con.dit .q S set= : oath in the
attached 'Conditions' Ai work sha1,1 � ��z5�ec,ord�rkc.e with Tcwn of South
Windsor standards, a :1 OSHA`:;:requiz.r'etq €;ids;<.r:;::;as3t >the a. 'tac e"t ;::`
h conditions.
Issued ByTile.: trri
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p Inspe'cted By --
Date Ins ected
APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $60.00
Location of proposed work: �' � . ., lei) 1) Lot # -Z-(-- ,r
Street No. Street Name
Premises owned by:
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
Existing Water Supply: Public Water_ Well
Proposed Start Date 6 S Estimated time for completionIF
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. �'�_ 7�It a 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.
Signed: l l � ��✓ �-�'�• Print Name:-
Licensed Drain Layer
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Date:_ ci IL `;UE
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: 65
BUILDING ADDRESS 06 ��`k
STREET XV-
+ SUBDIVISION: x
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CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPERVISOR (PRINT)
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STREET ADDRESS SIGNATURE
5&,L) A 4,4r7,/1oii, el 626G ' ,. DATE
TOWN STATE ZIP INSPECTED BY TOWN
9' 0 �r & S-.)-s-2 DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER