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HomeMy WebLinkAboutDrain Layers Permit 78 Steep Road TOWN OF SOUTH WINDSOR INSPECTION REPORT Permit No. 7727 Cgiatracto2_ JAME.SuTh--OWE Location 0078 STEEP ROAD Addxe:S< ?`<?: VAQ:'<S> GkER .&:.SEPTIC Type Work NEW SAN LAT DRIVE S ERM'0 0 6 0 6 5 phone No ($60) 8;90Q .S Date Insp Needed _ �Ai Dare VInff"� : Time Insp Needed _ _._ : Inspected By *� Work in Progress i �7+ �~ ' I+ r�l`i�S f ► �- �FV 'f'.�) ��j�' ----------------------- ' - ----------- --- - - -- - - ' Date Permit No. 7727 Town of South Windsor, CT Permit Date 04/05/2004 Drain Layer Permit Expiration Date 05/05/2004 Descrip: CK #745 $52.50 CK #,4416 . 8:O d"0 Applicant Lacat�>on a Name JAMES THROWE Adr1X s Ot7`8 STEEP RO1kD Addr. VANS SEWER & SEPTIC O4x31i r IWANICKI'TH©MA'S J 97 RIVERSIDE DRIVE ,. : VERNON C.-T 06066 Phone No. (860)289-00�5 ij— The Drain Layer assigned this RainaC h a u13d 110 se rssued by the st ate hereby and h er a ;... Y g a:�_ t e "t'e'"rms 'a'nd ccirir?st.�.zan� ,s-et:::.fort.�h in the attached 'Conditions 'A'11 work Shal"3:.:q: . yi. aQrdance wail Towh of South Windsor standards all OSH.A�" e.cjurmet'a;:<a €3°%Yz'e att;a'cHecl:;:;.. .onli i G t ons. Issued By Date Inspected p --------------------- T nsret'e t3<'>; y --------------------------- TOWN OF SOUTH WINDSOR SANITARY SEWER LATERAL FIELD LOCATION DATE OF CONSTRUCTION: BUILDING ADDRESS 7S' STREET : i It SUBDIVISION: NORTH ARROW i : _ t r I .... t t f - : i l : e c t 11 flik - : I ..._ _;..__ � �.._._.. __ ;--.—ten•.., r �; �`l. — 11 yyr I, ! I I ! 1 I : Y� `1 I f i ; i yl CONTRACTOR (PRINT) NAME OF CONTRACT R'S SUPERVISOR (PRINT) STREET ADDRESS SIGNA RE DATE TOWN -STATE ZIP INSPECTED BY TOWN DATE TELEPHONE NUMBER WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER 1�1 .` 7-7Z7 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 - Lot # Street No. Street Name Premises owned by: S, Lei Name of Firm:�lr�n� �,�Q.rp , Phone:2 � Address.of Firm: .TYPE OF WORK: Lay House Drain 0 Repair House Drain Lay Main.; Lay Lateral-for Commercial/Industrial Building of acres Connection will be made with 3 Existing Water Supply: Public Water Well Proposed Start Date o� Estimated time for completion (1f�164� ALL WORK TO BE IN ACCORDANCE WITH TOWN OF SOUTH WINDSOR STANDARDS, ALL OSHA REQUIREMENTS AND C NDITIONS ATTACHED TO THE PERMIT Permit is to be issued to the holder of Drain Layer's License No. 209-( 3 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. 9-y/-// .� __� Signed• �- U` Print Name: •-�q��s �-�— Licensed Drain Layer - Date:_ Q&k ® V Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc