HomeMy WebLinkAboutDrain Layers Permit 428 Pleasant Valley TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 8104 Cont,radtor J & "H""SLATCER CONST CO
Location 0428 PLEASANT VALLEY Address;`; <`::_ 75 COMMm'E'"WAY
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Type Work NEW SAN LATpu.TH WTN019OR CT., 06074
Phone-, No la q)5 8 '5252
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Date Insp Needed _ Dates Insp
Time Insp Needed
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Permit No. 8104 Town of South Windsor, CT
Permit Date 10/19/2006 Drain Layer Permit
Expiration Date 11/18/2006 i
Descri : INSTALL SANITARY LATERAL...f
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Applicant f' Lacati.on
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Name J & H SLATER CONST : O kd4$ 9k2$ P1BAS' NT VALLEY
Addr. 75 COMMERCE WAY bvin@r DEPIETAQ GENE'& K! THLYN M
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SOUTH WINDSOR CT...0607.4"
Phone No. (860)528-5252
The Drain Layer ass :gx ed-;C: Is P act his ?I$1�d ] tense ssu'ed by the
state and hereby agrees tc� Z1., he'ferms"arid c�o�xdite7 sit',forth in the
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wn of South
attached Conditions .. 'All vrork sli. 11 b � ��� x"d � h o
Windsor standards, all OSHA r-ell' rt+m�s�ts.; and the atta'ghed. Conditions.
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Issued BY Pr_ � �
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Date Inspected ---- �YYpected'' By --------------------------
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APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT Y
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $60.00
Location of proposed work:
�-��_, Lot
Street No. Street Name
Premises owned by:__(,(J
Name of Firm: V
Phone:
Address.of firm:
TYPE OF WORK:
Lay House Drain— Repair House Drain
Lay Main . '
Lay:Lateral-for Commerdai/Industrial
Building of.
. -- acres .
Connection will be made with .
Existing Water Supply: Public Water Well
Proposed Start Date d Estimate time for completion
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ALL WORK TO BE IN ACCORDAMCE WTiNTOWN OF SOUTH WINDSOR STANDARDS,
ALL OSHA.REQUIREMENTS AND CONDITIONS ATTACHED TO THE PERMIT
Permit-is to be issued to I
Layer's License No. _2�t 7yq the holder of Drain
will be issued.a Only holders of P-1, P-7.or W-9 licenses 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.
Town Street Excavation Permit No. Applicant has received
and/or ConnDOT Permit No.
CBYD No
Signed: Print Name: �-
Licensed Drain Layer
Date: L 6 tg 6k,
Standard Forms\PermIMAPPLICATION FOR DRAIN LAYERS PERM1T.doc
�. TOWN OF SOUTH WINDSOR
SANITARY SEWER .. LATERAL FIELD LOCATION
DATE, OF CONSTRUCTION:
BUILDING ADDRESS e4f ror j/e,
STREET : All
SUBDIVISION. r
NORTH ARROW .'
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70 Oe,,osj' v/ f'JZa
CONTRACTOR (PRINT) NAME OFCONTRACTOR'S SUPERVISOR (PRINT)
STREET ADDRESS ; SIGNATUgE
X. C7— 04U1'y � � 1� DATE
TOWN STATE ZIP INSPECTED BY TOWN
Lfe fi �'- s"15rj DATE
TELEPHONE NUMBER
WHITE - TOWN PINK CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER
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