HomeMy WebLinkAboutDrain Layers Permit 505 Pleasant Valley 1
• TOWN OF SOUTH WINDSOR INSPECTION REPORT
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Permit No. 7713 Contra>ctoY"JAXES...- HROWE
Location 0505 PLEASANT VALLEY Addzess VANS SEWER:;..& SEPTIC
Type Work NEW SAN LAT 97 RTUERIDE DRIVE
VERNON: CT 0...6066 ::..
Plzc>ne No #860)_.289 0095
Date Insp Needed ----------- -- Date_;fin p � iYy�
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Inspected By
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Input - Date
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Permit No. 7713 Town of South Windsor, CT
Permit Date 03/08/2004 Drain Layer Permit
Expiration Date 04/07/2004
Descrip:
Applicant Loat`i.on
Name JAMES THROWE WANT; VALLEY
Addr. VANS SEWER & SEPTIC Ovaner„LYKE SE:EPHSN F & ALICE KAY
97 RIVERSIDE DRIVE.":
VERNON CT06066 '
d
Phone No. (860)289-0095
The Drain Layer assigned this p ;zi -hds a vkid, license iz, 1A d by the
state and hereby agxees to a.11` the terms 'and coriii:ditioris set.;,forth in the
attached 'Conditions' All w6x caxdanee Wit h Town of South
Windsor standards, al]. 0SI3A requirements; rd the attachei�,.,.:conditions.
Issued By
Date Inspected --------------------- Irispi'Ctted By ---------------------------
3
-4 7-7/3
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 ro sed work: o S V(Aqp po � Lot #
Street No. Street Name
Premises owned by: (.c% ,r-j
Name of Firm: Phone: 85C�c�
Address.of Firm:
TYPE OF WORK:
Lay House Drain ; Repair House Drain
Lay Main ; Lay.Lateraf for Commercial/Industrial
" Building of acres
Connection will be made with Z R 3 S'
Existing Water Supply: Public Water --� Well
Proposed Start Date /D0WoL/ Estimated time for completion J1 ghl?01/
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 �avne,3` 0)W-U the holder of Drain
Layer's License No. o Only holders of P-11 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: Print Name: amps l�i,�o a
Licensed Drain Layer
Date: YE
�/�'6 l
Standard Forms\Permits\APPUCATION FOR DRAIN LAYERS PERMIT.doe
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TOWN OF SOUTH WINDSOR
SANITARY - SEWER LATERAL 'FIELD LOCATION
DATE OF CONSTRUCTION;
BUILDING ADDRESS .�" s P� �s �•� Y��`��y R�
STREET
SUBDIVISION:
NORTH ARROW
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CONTRACTOR (PRINT) NAME OF CONTRACT S SUPERVISOR (PRINT)
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STREET ADDRESS SI RE
!s'4-r?Alo Al �' �' ®6a 4,6 � -� ®� ri s � DATE
TOWN STATE ZIP INSPECT�C� 9Y TOWN
'fee z 8 9 -o o )s' DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER