HomeMy WebLinkAboutDrain Layers Permit 1261 P{easant Valley TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 7986 Cont.pa<(ftor SKIPS""SEPTIC
Location 1261'PLtA9AhTtt' VALLEY 46dresa.. :. 27 MUDIkI' BRO'Q ROAD
Type Work NEW SAN LAT
Phone 'I*IO (8$Q)8`15 23�2 ::
Date Insp Needed
Time Insp Needed Time InC ?
------------ y t
Inspected By
Work in Progress -----! � t
r�`,.4r { - --
C,l� Input _ D' te
~ / -------------- i
i
Permit No. 7986
Town of South Windsor, CT
Permit Date 10/21/2005 Drain Layer Permit
Expiration Date 11/20/2005
Descrip: CK 2158 $3511.50 FOR;'S PERI?'i S j
Applicant
Looataon i
W.
Name SKIPS SEPTIC Acjc 1 fX pLE S; VAISLEY
Addr, 27 MUDDY BROOK ROAD (}C 1atr BALDYGA ;,9TATgLE"Y P U
ELLINGTON CT,`0 029
Phone No. (860)875-2332
)
The Drain Layer a5sign�d thas pettt�t has a ualxd license issued by the
state and hereby agrees tq ail` the'teYms and cdiditz04 set;: forth in the
attached Conditions)::. :�11`=:v�'v k'_:'s'T'..:;2 ;'' <:<:: <`<:;'<:.<.::;........::.::.......`.,::..'.
s ? 3 Qcb:r anee Wst,4 Town of South
Windsor standards, all OSHA pef'uirert.-.0 aid tkfe attached, Conditions.
Issued By
Date Inspected p --------------------- Inspected By ---------------------------
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL _FIELD - LOCATION
DATE OF CONSTRUCTION: 1 `� $ "� a
BUILDING ADDRESS
STREET
-I- SUBDIVISION:
NORTH ARROW
._.
f
t-N
. . ........
/-T.L_ N,/
CONTRACTOR (PRINT) NAME OF CONTRACTOR'S PERVISOR (PRINT)
c
,odd oak l -z--6s,
STREET ADDRESS V SIG
rIT
NZ
TOWN STATE ZIP INSPECTED BY TOWN
DATE
TELEPHONE NUMBER
WHITE TOWN PINK - CONTRACTOR YELLOW CONSULTING ENGINEER / DEVELOPER
-7 9J6
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:_ �, 6 / ��E�s, -j rrFl,%,c y Lot #
Street No. Street Name
Premises owned by: Srn yl- r. y 2,1 4-0
Name of Firm: /�S Phone:
Address.of Firm: 0, No X 2 c� � 1 G-M A/
TYPE OF WORK:
Lay House Drain x ; Repair House Drain -
La Main
Y -
; Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with `` f>VCExisting 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 4j192-k£ the holder of Drain
Layer's License No. 2 a 1 7 zso, 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: Print Name: 7 i9S 4j&k %Z
License. Drain Layer
Date: /6 0 S�-
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc