HomeMy WebLinkAboutDrain Layers Permit 89 Robert Drive �► TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. Contractor SKIPS SEPTIC
Location 759 {> Address 27 MUDDY BROOK ROAD
Type Work SAN LAT ELLINGTON CT 06029
Phone No. (860)875-2332
Date Insp Needed 1 p I O p Z-
T i me I nsp Needed {n a; 6 PM
Inspected By
Work in Progress STu$
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Perri-t :�o. 7590 Town of South Windsor, CT
Re rklio1a? ate 10/10/2002 Drain Layer Permit
Expiration Date 11/09/2002
Descri p:
Applicant Location
Name SKIPS SEPTIC N r 089 ROBERT DRIVE
Addr. 27 MUDDY BROOK ROAD r r4L GO OLGA L/U
ELLINGTON CT
Phone No. (860)875-2332
The Drain Layer is 1 icense issued by the
state and hereby ag ean ns set forth in the
attached 'Condition rk l in a with Town of South
Windsor standards, 1 an ached conditions.
Issued By
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Date Inspected
Y
s` TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: /o L
t I BUILDING ADDRESS
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STREET I& _
SUBDIVISION:
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CONTRACTOR (PRINT) / NAME OF CO RA �R� SUPERVISOR (PRINT)
STREET ADDRESS SIGNATURE
nn e A DATE
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TOWN STATE ZIP INSPECTED BY TOWN
DATE
TELEPHONE 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 $25.00
Location of proposed work: 13? agQa-r Lot #
- - Street No. Street Name
Premises owned by: 4� 6 A k 0A1 6 d
Name of Firm: 6kI PS d fPrc= S'0?zvl L Phone: g71- Z-- 3 s 2 -
Address of Firm: 2-7 N"D41 �Izodk /2� "��. /.,j 6?74J
TYPE OF WORK:
Lay House Drain X ; Repair House Drain ;
Lay Main ; Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with siyt 3 5- P v C-
Existing Water Supply: Public Water Well X
Proposed Start Date 16-4-o Z Estimated time for completion /p_fS= n Z-
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 -rz% �,� t the holder of Drain
Layer's License No. Zo? '!Z.!r- Only holders of P1 or P7 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. 4-100 6¢0
Signe . Print Name: 4164 cIZ
Licensed Drain La r
Date: /0 - r0 0 Z
Standard Forms\Permits�APPLICATION FOR DRAIN LAYERS PERMIT.doc