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TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 7722 Cont.:-.a'C'tor DOUBLE`r`C.:-�:CONSTRUCTION LLC
Location SHADYBROOK ,Addres,�F:` <:'`-P 0:::$:aX:'785 `4<5, EVANS RD
Type Work SAN MAIN ROCKY H LLsCT:• 06067
Phone'.no 4 )
Date Insp Needed f Date i2�B
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r Permit No. 7722 Town of South Windsor, CT
Permit Date 03/31/2004 Drain Layer Permit
Expiration Date 04/30/2004
Descrip:
Applicant Location
Name DOUBLE C CONSTRUCTI:ON LLC Ad,dr SHADYBROOK
Addr. P 0 BOX 785 45 E.VANS RD ' Owrier
ROCKY HILL CT 06067' `
Phone No.
The Drain Layer asssgne.d this pexmat has . vd7id Iicense;'issued by the
state and hereby agrees to alT' the terms 'and corditinne set;.:forith in the
attached 'Conditions' . Al1 work shah ben aotrdanC'e, wit;h Town of South
Windsor standards, aI'1 OSHA requirements ':and the attached,,,,.coziditions.
Issued BY
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Date Inspected Ins ected B Y �' --
APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
n' FEE $60.00
Location of proposed work: I Lot #
Street No. Street Name
Premises owned by: 1:7Ir✓f 1,t
Name of Firm:_ �,; ,i,l 1 . {f. L�, Phone: i !cU2
Address.of Firm: y S E/c,1)s
TYPE OF WORK:
Lay House Drain _; Repair House Drain
Lay Main_ x �; Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with C IU,,�
Existing Water Supply: Public Water_ Well
L' f �
Proposed Start Date ; i S 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 l�r, J 1 s .j r) th holder of Drain
Layer's License No. 7��? f Only holders of P-1 P- or W-9 licenses
will be issued a permit. PERMIT WILL EXPIRE THIRTY(30 AYS 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: & ��;n ��`/ .L_� Print Name: L7r, Ii'u�l
Licensed Drain Layer
Date:_
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc