HomeMy WebLinkAboutDrain Layers Permit 35 Stedman Circle .�
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r TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 6912 Contractor WILCOX, MICHAEL (EAGLE)
Location 0035 STEDMAN CIRCLE Address EAGLE EARTHWORK SERV.
Type Work NEW SAN LAT 101 N MOUNTAIN ROAD
CANTON CT 06019
ghghe No, (860)693-2027
Date Insp Needed ate Insp, " �llO l!�Time Insp Needed ti.n�• �' me Insp
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Input .,, Date
er,�a1o. 6912 Town of South Windsor, CT
ermij,t ,jPate 11/09/1998 Drain Layer Permit
xpiration Date 12/09/1998
ascrip: PERMIT RENEWAL
Applicant Location
ame WILCOX, MICHAEL (EAGLE) Addr . 0435 STEDMAN CIRCLE
Jdr. EAGLE EARTHWORK SERV. -Owner''BLOZJE REGINA M ET AL
101 N MOUNTAIN ROAD
CANTON CT QfQ 9
ione No. (860)693-2027 ,
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The Drain Layer as�!g06.d phis perm l ifcense issued by the
state and hereby agrees to ill. therm and o'csn�;itzons set forth in the
attached 'Conditions ' Al 1 "W' o`rk sha 1 1 ba in accord`ancei` w i th Town of South
Windsor standards, all OSHA recui:r_,,"bnts, °and ,the 'attached conditions.
sued BykNA 1 .i`1►1e
tte Inspected _-� - - In
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TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS � - -
STREET MA/1�
SUBDIVISION: -
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CONTRACTOR (PRINT) f NAME CONTRACTQR'S SU�;ERVIS )R (PRINT)
I
STREET ADDRESS SIGNATURE
DATE
TOWN STATE ZIP INSPECTED BY TOWN
H DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER
APPLICATION FOR DRAIN LAYERS PERMIT6�12-
• TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE$25.00
Location of proposed work �51ea0 �G1 C�/Ll� Lot # Z2�-
Street No. Street Name
Premises owned by: ce/YGi i
Name of Firm: Phone:- 5' -00 Z 7
Address of Firm AV
TYPE OF WORK:
Lay House Drain�_; Repair House Drain ;
Lay Main ; Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with
Proposed Start Date I (-Ib 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 c(i�C � L W lC� the holder of Drain
layer's License No. Z 70 J( 6 Only holders of P1, P7 & W3 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.
Signed: Print Name AC titre,0l
Licensed Drain Layer
Date: