HomeMy WebLinkAboutDrain Layers Permit 565 Rye Street a �
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD
LOCATION
DATE OF CONSTRUCTION: �� Z
BUILDING ADDRESS
STREET
SUBDIVISION:
NORTH ARROW
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CONTRACTOR (PRINT) NAME OF CONTRACTO 'S SUPERVISOR (PRINT)
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STREET ADDRESS SI TURE
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TOWN STATE ZIP INSPECTED BY TOWN w
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TELEPHONE NUMBER
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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: 6-!�- Ri'f-e---, Lot #
Street No. S eet Name
Premises owned by: Elr� A -I�hoyiio
Name of Firm: ' 1'�z �'�`��- �� C Phone:
Address of Firm:
TYPE OF WORK:
Lay House Drain Repair House Drain ;
Lay Main ; Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with _ SOP 3 S
Existing Water Supply: Public Water Well
Proposed Start Date Estimated time for Completion 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 �►^� the holder of Drain
Layer's License No. o . 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.�20G 0 0 l
Si ned: 7L Print Nam :_. 5-
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Licensed Drain Layer
Date: (,,) Ave4-L
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
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Permit No. °.# Contractor JAMES THROWE
Location �ETI Address VANS SEWER & SEPTIC
Type Work >, ► T 97 RIVERSIDE DRIVE
VERNON CT 06066
on No. (860)289-0095
Date Insp Needed g I g d
Time I nsp Needed
Inspected By
Work in Progress
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Pem`iA No. 7481 Town of South Windsor, CT
Pofrmit Date 08/06/2002 Drain Layer Permit
Expiration Date 09/05/2002
Descrip: 1 .00 CASH
Applicant ` Location
Nam Adder.
THROWS ,ON' C 0 5 RYE STREET
. VA NSEWER & SEPTI r NSO RICHARD N & SUSAN K (SU
97 RIVERSIDE DRIV
VERNON
Phone No. (860)289-00
The Drain Layer i h ' ha 1 license issued by the
state and hereby ag 11 an i ons set forth in the
attached 'Condition u: in rce with Town of South
Windsor standards, 1 e r tached conditions.
Issued By c
Date Inspected 0 ID I G by