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TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 7779 Co.. actor._ COVi N:5TRUCTION CO.
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Date Insp Needed
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Time Insp Needed 0/11 (91i'1E�YK,
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Permit No. 7779 Town of South Windsor, CT
Permit Date 07/16/2004 Drain Layer Permit
Expiration Date 08/15/2004
Descrip: INSTALL SANIT. SEW. fITEM4
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Applicant
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Name COVEN CONSTRUCTIQN 0 C;AJ,Tj 6.W R
Addr. P.O. BOX 427 :fy> : rry�ILHEL ::>WTaYNE Fi & `SARA B
COVENTRY t C
60
0 2 2-O5 Phone No. .: :
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The Drain Layer assigned t s d 1�Censb ss,�;ued by the j
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state and hereby agre Cr 1.es; . r1 ,>the terms and con$i af;or. h in the j
attached 'Conditions `All Sao 1� Sha ordailpe with Town of South
Windsor standards, a1i. 0S4A irem f a xic h`@., att chec::>Pori'ditions. j
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Date Inspected ____ _________ Inspen`i:exi'By
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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: b5rtlmiL m ea d fix ) Lot #
Street No, Street Name
Premises owned by:
Name of Firm:_ C,0 U C'd V1 S`h?_ Phone:
Address.of Firm:
TYPE OF WORK: y /
Lay House Drain �/ Repair House Drain
Lay Main_.:. ; Lay Lateraf for Commercial/Industrial
Building of acres
Connection will be made with (a V C,
Existing Water Supply: Public Water_ Well
Proposed Start Date 'b Estimated time for completion
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 hold rs of P-1, P-7 or W-9 licenses_
will be issued a permit. PERMIT WILT. 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:
"ceT yer
Date:
Standard Forms\ ermitswPLi TtoN FOR DRAIN LAYERS PERMIT.doe