HomeMy WebLinkAboutDrain Layers Permit 26 Redrock Lane TOWN OF SOUTH WINDSOR INSPECTION REPORT
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Permit No. 7 5 Cont otg'r JACQt7 -QQNSTRUCTION (JOHN)
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Permit No. 7785 Town of South Windsor, CT
Permit Date 07/23/2004 .>'•f^"^" ' ;:,,_ Drain Layer Permit
Expiration Date 08/22/2004 $
Descrip: INSTALL SEWER LATERAhd
Applicant :y "' :. °> ,'` "3' LCS' 1..t3,on
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Name JAC UES CONSTRUCTACW 4z
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Addr. 67 RIDGE ROAD a r CLARK ALT... PT
SOUTH WINDSOR C.T.,`7 0.Q 7; "'�: :'�
Phone No. (860)432-1&21-
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TOWN OF SOUTH WINDSOR
SANITARY SEWER LATER AL FIELD LOCATION ,: -
DATE OF CONSTRUCTION: ��'
BUILDING ADDRESS
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CONTRACTOR (PRINT) NAM OF CONTRACTO ' UPERVISOR (PRINT)
9 7
STREET ,ADDRESS SIGNATURE t
w 7 S D r C/T 0 4 ® 7� 1C.� e•�6 DATE
TOWN STATE ZIP INSPECTED BY TOWN
O 6 DATE
T LEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER
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: ior� l Lot #
Street No. Street Name
Premises owned by: Z a
Name of Firm. Phone:
Address.of Firm: �5-8, ill CY S,0A W, ,, WSc)e,;-
TYPE OF WORK:
Lay House Drain Repair House Drain
Lay Main ; Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with S 3
Existing Water Supply: Public Water Well
Proposed Start Date �' Estimated time for completion
7-7
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 ;W6/rT -)&Me holder of Drain
Layer's License No. a0FK3�2 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: 30A/ U cQue
Lice d r n Layer
Date: 7 a 3
Standard.Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc