Loading...
HomeMy WebLinkAboutDrain Layers Permit 19 Stevens Road (2) TOWN OF SOUTH WINDSOR INSPECTION REPORT !� Permit No. 7158 Contractor JACQUES CONSTRUCTION (JOHN) Location 0019 STEVENS RD Address 67 RIDGE ROAD Type Work NEW SAN LAT SOUTH WINDSOR CT 06074 " Phon"e No. (860)432-1823 � i Date Insp NeededDatc; Insp t Time Insp Needed f1me. I rrsp' I Inspected By Work in Progress i Input Date Pel'rri'Yt No. 7158 Town of South Windsor, CT Permit -Date 06/12/2000 Drain Layer Permit Exj`ri ation Date 07/12/2000 pescrlp: LOT 37 CK16689 $1233 . 37 , 16690 $195 .00 CASH $5 . 00 Applicant Location Name JACQUES CONSTRUCTION (Jo HN) „ A`dtlr,- 0019 STEVENS RD Addr: -67 RIDGE ROAD Qr"fie"r aMJ" CONSRTUCTION COMPANY SOUTH WINDSOR CT Phone No. ,:(860)432-1823 ' The Drain Layer as.i: ra h 's ��rmt. hs a 11 cl ,license issued by the state and hereby agrees" 1rd' t,1 � erm ,and"' c©ndi dohs set forth in the attached ',Conditions':. ( 0r-k shad I n ab�0$, p with Town of South Windsor standards, ai:l° OSN11 regtui romentt ' ,sand tMe attached conditions. Issued By /G" '-� �t1e .' a► Date Inspected 6 z �nspejc d By �-� g "j TOWN. OF SOUTH WINDSOR SANITARY SEWER LATERAL FIELD LOCATION DATE OF CONSTRUCTION:` BUILDING ADDRESS o 3 STREET SUBDIVISION: f NORTH ARROW - r -4- ------- � E 4- vil, bill i 2,1 _ �,a✓ � � � l ! _ ! t i f _ f � I i {{ - } y CONTRACTOR (PRINT) NAME 9F CONTRACTOR' S ERVISOR (PRINT) STREET ADDRESS SIGNATURE CT 06 DATE TOWN / STATE ZIP I SPECTER; BY TOWN DATE TELEPHONE NUMBER WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER APPLICATION FOR DRAIN LAYER PERMIT TOWN OF SOUTH WINDSOR PUBLIC WORKS DEPARTMENT TOWN HALL 1540 SULLIVAN AVENUE SOUTH WINDSOR, CT FEE $25.00 Location of proposed work: Lot #3 Street No. Street Nam Premises owned by: M Cz a4 c- Name of Firm: Phone: 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 171,01eo Estimated time for completion ALL WORK TO BE IN ACCORDANCE WITH TOWN OF SOUTH WINDSO STANDARDS, ALL OSHA REQUIREMENTS AND CONDITIONS ATTACHED TO THE PERMIT Permit is to be issued to 131OW 11CQ the holder of Drain Layer's License No. ?OS?3 O my holders of P1 or P7 licenses will be issued a permit. PERMIT WILL EXPIR 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: Lice d Dr Layer Date: - /eApIlmi - Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc