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HomeMy WebLinkAboutDrain Layers Permit 69 Riverview Drive 4. TOWN OF SOUTH WINDSOR INSPECTION REPORT Permit No. 7669 Contj:,Er J & H `SLATER CONST CO Location 69 RIVERVIEW DR PODUNK RIDGE ::Address. ?.75 COMMERCE`"W,AY Type Work NEW SAN LAT SOUTH WINISSOR CT.. 06074 Phone'No {$50)528=5252 Date Insp Neededi Date In p � Time Insp Needed Time Inspected By M. Work in Progress ---= -- -'-- Cd� 40 Input _ Date _:....... is 11 I! I� .I J � !i it Permit No. 7669 Town of South Windsor, CT Permit Date 09/22/2003 Drain Layer Permit 3 Expiration Date 10/22/2003 j Descrip: FEES FOR 28,36,40 70 78 94 95 69 .a 21 1'SAME .CFTECK Applicant I Location i Name J & H SLATER CONST CO Ad DUNK RIDGE c1r 5J RSVERVIEW DR PO !: Addr. 75 COMMERCE WAY Omer i SOUTH WINDSOR CT, 06A14 g Phone No. (860)528-5252 ` �r i The Drain Layer assigned tkas pejtt has a vladcenSe'xseued by the state and hereby agree-s _.t0 1' the terms and conc�itioriset.:f,oYth in the attached 'ConditiAll wd''k 'h. 11 1# a csrdaxiC tvi,th Town of South Windsor standards, all OSHA requir�ments, , d the attached : anditions. Issued By -- — ------ ---------- Date Ins ected �_.,_ p ----------- Inspec'Eed By ---- TOWN OF SOUTH WINDSOR SANITARY SEWER LATERAL FIELD LOCATION DATE OF CONSTRUCTION: BUILDING ADDRESS 1 STREET �6-14-01 6w lb kl✓C SUBDIVISION: Pb�-b v I b G 6 NORTH ARROW 1 ; )- _- I j , 1 q , ✓ 1 } r 7 40,X!- �X I 7 7 1 I 7 I i i {{ , f I i ! i i , f s 1 1u 3 C~ i I 7 I i • 7 , 7 i I co I�� CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPERVISOR (PRINT) rl � t-D��,G(L C- STREET ADDRESS dd SIGNATURE a�n�' �,J a � .. L-(' O 1� >7 ��. _ g�.2 v3 DATE TOWN STATE ZIP INSPECTED BY TOWN © 7- D �o S c Jy— ��' DATE TELEPHONE NUMBER WHITE — TOWN PINK — CONTRACTOR YELLOW — CONSULTING ENGINEER / DEVELOPER --I ��d. APPLICATION FOR DRAIN LAYER PERMIT ��� >4 0 TOWN OF SOUTH WINDSOR 5 PUBLIC WORKS DEPARTMENT �� 'n� TOWN HALL 1540 SULLIVAN AVENUEj�`' f�(� SOUTH WINDSOR, CT FEE $60.00 (� Location of proposed work: 6U-k T t ( At) �.: �� Street No. Street Name «, ( �t Premises owned by: Name of Firm: Jr- C a r CA, Phone: Address.of Firm: WA-1 TYPE OF WORK: Lay House Drain ; Repair House Drain Lay Main ; Lay Lateral'for Commercial/Industrial Building of acres Connection will be made with Existing Water Supply: Public Water Well Proposed Start Date 9- Z:5-03 . Estimated time for completion att 1 14 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 _ ilZ the holder of Drain Layer's License No. 3'"17 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 andattached thereto. Applicant has received Town Street Excavation Permit No. and/or ConnDOT Permit No. CBYD No. Signed: Print Name: kt )w'jtT6(Z- Licensed Drain Layer Date: Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc