HomeMy WebLinkAboutDrain Layers Permit 17 Redrock Lane TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 7740 Contra.c,*9,v,1ff-A0tU-;" CONSTRUCTION (JOHN)
Location 0017 REDROCK LANE Add Tes t :?a. 67 R�;�G� kbA
Type Work NEW SAN LAT 1" t'Ct" £r'8:0UT#'yVd :ND.��R :T. 06074
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Date Insp Needed �at'e-:v<Sri` .
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Permit No. 7740
Permit Date 05/04/2004 Town of South Windsor, CT
Expiration Date 06 Drain Layer Permit
Descrip: CK 12966 $955.00 CK 1'29,6 f:y 3 "'0A.
Applicant
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Addr. 67 RIDGE ROAD v' 4 ><::: ��: :3. EI)$O<C:h'"SANE`:>.
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SOUTH WINDSOR 'jil
Phone N a:y<.o. (860 4 32- '�.182 3"'s<;
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state and hereby agre tot � cens rued by the
Conditions e terms and cond'i�, pp�r :set,,for h in the
attached 'A71 wnr9c shill ,
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Windsor standards a11. OS Xt °rdanc�- W'th Town of South
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Issued By ---------------
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Date Inspected
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TOWN OF SOUTH WINDSOR
SAN ITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: o o
BUILDING ADDRESS G- l
STREET 0 ck Lam
SUBDIVISION: ��
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CO TRACTOR (PRINT) NA OF CONTRACTOR'S SUP RVISOR (PRINT)
STREET ADDRESS - SIGNATURE
r- DATE
TOWN STATE ZIP INSPECTED BY TOWN "
AD DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER
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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: c�
Street No. Street Name
Premises owned by:= 110 j (fc�� 5
Name of Firm: 0%�9 ��,� �hf ��
� .Phone:.
Address.of Firm:
TYPE OF WORK:
Lay House Drain Repair House Drain
Lay Main • Lay_Latera[for Commercial/Industrial
Building of acres
Connection will be made with DIP J
Existing 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
�` the holder of Drain
Layer's License No. �o�cg 3,0 Only olders of P-1, P-7 or W-9 licenses
will be issued a permit. PERMIT WILL EXPI E 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: ti► 5,r Co L es
Licensgd Dr ' yer
Date:
Standard Forms\PermitsWPLICAIION FOR DRAIN LAYERS PERMrr.doe