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HomeMy WebLinkAboutDrain Layers Permit 105 Scott Drive i TOWN OF SOUTH WINDSOR INSPECTION REPORT Permit No Coa�tr ctor HOME6"'Pa Location Type Work N SAN LATAME�lEddr £. S. ABCJ"6tF> ...: AV G.U711 CT`'-06074 . _ . Date Insp Needed ------------- — ..:,....... "AK, Y Time Insp Needed �� ------- ---- �— -yy : : zri Inspected By �� Work in Progress MZ ©G .'t:Ck -- ------- mod. �— o' I I ii 'I Permit No. 7916 Town of South Windsor, CT � Permit Date 05/10/2005 �•' '°"'"^k<.>:• Drain Layer Permit Expiration Date 06/09/2005 a "'v'' ""^ Descrip: PP A licant bbb,e Lion Name HOMEOWNER �SCOTT f.Z Addr. SAME AS ABOVE ftYjer HANN `( N- S(?��II� E ' RENEE E 1 SAME AS ABOVE 21 s g x 3 e4 . SOUTH WINDSOR 4.7 6E07'4'. ;ra G Phone No. (000) 000-O'01:Qz ::23; i v,F.,: ::j ^:'i'i.?t> + e?-'::9 ,'!;• :,:.;::Yv,:p;:., .... OU fflW The Drain La er`% a§s � ', d Y g 1 a -lid ?ic�cr se<I ued by the j state and hereby ar%,* ix 7 . the ` 'ertnPi'd" . ...6qt;,..fc-th in the attached 'Conditions'`< -Wi.:th 3'T.-Own of South Windsor standards, al.l 0$H1 >' iz .` `"`" >4 t' ch8d.,>c.0nditions. w Issued By a. Date Inspected --------------------- 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: 5 C �C- Lot # Street No. Street Name Premises owned by: r t Name of Firm f�:�e®o•%a er Phone:bs--�9-6 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 Existing Water Supply: Public Water_ Well Proposed Start Date 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 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. Z aes--1 4-o y336 Signed: Print Name. Licensed Drain Lay Date: U Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc TOWN OF SOUTH WINDSOR SANITARY - SEWER LATERAL FIELD LOCATION DATE OF CONSTRUCTION: y/off BUILDING ADDRESS : 10S Sea i ! brz ✓E STREET . SA M E -I- SUBDIVISION: ALL PIPE is 6 PVC As ENO c✓ N I w SPEL, NORTH ARROW &-mD- 45' Y-f 226 a�,�D 3--226 OLN05 I Ile 1 S _ 5 w kis CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPERVISOR (PRINT) STREET ADDRESS SIGNATURE DATE TOWN STATE ZIP INSPECTED BY TOWN DATE TELEPHONE NUMBER WHITE — TOWN PINK — CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER