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TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 7679 Contras` or J & `H"°'S-LA.TER CONST CO
Location 20 RIVERVIEW DR Address. 75 CQMMRRCE'==>In7AY
Type Work NEW SAN LAT
.QUTH WINtTSOR CT 06074
Phone!& (Bi"D 5,28-52.52
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Date Insp Needed Datr 'T�isp
Time Insp Needed Time T -
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Work in Progress �
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Permit No. 7679 Town of South Windsor, CT
Permit Date 10/22/2003 Drain Layer Permit
Expiration Date 11/21/2003
Descrip: CK 10900 $6639.00 SIX P<ERMIT.$::; $ .00 :;;BASIL_
Applicant Location
Name J & H SLATER CONST CO Atltr 20 i RIVERVIRW DR
Addr. 75 COMMERCE WAY 7Wn@ FSK,..KELLC0
SOUTH WINDSOR CT 06074
Phone No. (860)528 5 2.5 2
The Drain Layer.asS., �ie this permit has'a valid lzcense -issued by the
state and hereby a ;rees t terms an€i set . :.firth in the
attached 'Conditions' A11 wgxl€ shall'be xt aacordance ri.th.; Towh of South
Windsor standards, all OSFTA requirem azrd theattachsd conditions.
Issued BY7"-` _ Title �c
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Date Inspected ------------- Inept t'ed By
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD . LOCATION
DATE OF CONSTRUCTION: !a -213--a 3
BU I-DING ADDRESS
STREET : -tUC7 -V1ey �-� C
SUBDIVISION: _1� V.r')k rz-I t> G
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CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPERVISOR (PRINT).
STREET ADDRESS SIGNATURE
Of
"s h L�-f W I o DS�N 7 !- y DATE
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TOWN STATE ZIP INSPECTED BY TOWN
S45 DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER
7179'
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: �0 lx,t IJ Lam- b(, Lot #
Street No. Street Name
Premises owned by: (C ° tC�Cc_CQ1
Name of Firm:j 9 t4Tr=0--eG IS c 16�Cyj , Phone:
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Address.of Firm: Kitlh Ear_,E
TYPE OF WORK:
Lay House Drain Repair House Drain
Lay Main ; Lay Lateraf for Commercial/Industrial
Building of acres
Connection will be made with
Existing Water Supply: Public Water_ Well
Proposed Start Date -63 Estimated time for completion 2 U(66r-5
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. 207 ?L 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 anq attached thereto. Applicant has received
Town Street Excavation Permit No. and/or ConnDOT Permit No.
CBYD No.
Sign Print Name:_ �_J - SL4r&z
Licensed Drain Layer
Date: 1
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc