HomeMy WebLinkAboutDrain Layers Permit 598 Rye Street t �
TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 7954 Contract"or.HOMEOGIN`SR,,,:
Location 0598 RYE STREET Atdree39u `":SAME":AS:'ABOVE.,.
Type Work RPR SAN LAT SAME, AS`'ASpVE
gUTET VftN.)SOR CT 06074
:
PhonE No (jy;L�.0)000-:000.0
Date Insp Needed _____________ Dat Tns
Time Insp Needed
.............
Inspected By
i
Work in Progress
x
s -
:
------------------------------- ----- ---- — —
Input 'T 3a4te
i
Permit No. 7954 Town of South Windsor, CT
Permit Date 08/09/2005 !
Drain Layer Permit �
Expiration Date 09/08/2005 I
Descrip: REPAIR SEWER LATERAL.:."
A licant
PP 'L '< a:at''on
3
Name HOMEOWNER XddY 0599 RYE; RE$T
Addr. SAME AS ABOVE ;' awitr ALATIS ..,:TAR`A M""& ;ONY
wTi
SAME AS ABOVE
SOUTH WINDSOR CZ 074
Phone No. (000)000-00.00 _ {
f
The Drain Layer assigned tlxss Fex2 �t has a vid ]s: ense. sled by the
state and hereby agrees to all the terms and ConC'€i.tl3jn �3et:forth in the
attached 'Conditions .-A'll woxk shall be an atcnrdane withTovin of South
Windsor standards, all OSHA @c u t[;ez�t a ti;d .i'e atta-Ae(3,...conditions. '
n
Issued By ---- -F-�A _— TatJ ... .» �
. i—ee.---e/--------------------
Da ,..
to Inspected -------------------- lrfspect'e<3':;:"By _
I ,
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS
T
STREET
-�- SUBDIVISION:
NORTH ARROW
ing
i
CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPERVISOR (PRINT)
-C�- �Sa
STREET ADDRESS_ SIGNATURE 0
DATE
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 $60.00
Location of proposed work: s/ e li E_ S 1 Lot #
Street No. Street Name
Premises owned by `� (\ 5, L �
Name of Firm:_ I\j Phone: 4
Address.of Firm: f�f
TYPE OF WORK:
Lay House Drainer Repair House Drain J��f�,
Lay Main . ; Lay Lateral-for Commercial/Industrial
Building of acres
Connection will be made with P j
Existing Water Supply: Public Water Well
Proposed Start Date Estimated time for completion e
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. 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:
.Licensed Drain Layer
Date:
Standard forms\Permits\APPLICAIION FOR DRAIN LAYERS PERMIT.doc