HomeMy WebLinkAboutDrain Layers Permit 48 Stevens Road s
TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 7172 Contractor JACQUES CONSTRUCTION (JOHN)
Location 48 STEVENS RD Address 67 RIDGE ROAD
Type Work NEW SAN LAT SOUTH WINDSOR CT 06074
PhQ,e .No. (860)432-1823
Date Ins Needed ��� Q. Date Ins' 5 7. ®C
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Time Insp Needed / ►me "Insp
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� mit No. 7172 Town of South Windsor, CT
Pe,rmmit: Date 07/20/2000 Drain Layer Permit
Exp•1ration Date 08/19/2000
"Des_crip:
Applicant Location
Name JACQUES CONSTRUCTION (, OHN _: Add
r: 48, STEVENS RD
Addr . 67 RIDGE ROAD owner "
SOUTH WINDSOR CT;�'Q0 j 17=
Phone No. (860)432-1823 '
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The Drain Layer ass't rre th, s P, r*i t has za v 7 d 1 h tense issued by the
state and hereby agr`es tc lj1 the tilIri and of iti,o s set forth in the
attached 'Conditions 'y ; ;.Al `4rk shag1£ n a o6r�dance with Town of South
Windsor standard-, a 1 l 44tr, its, xnd # ,'Attached conditions.
Issued By ti `tly � -
\ g 3 ir�r E P,
Date I nspecte
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TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: pt o o
BUILDING ADDRESS �D
STREET ,�t e y Qns k B e;i Jt
CID f a Lt 7
SUBDIVISION:
NORTH ARROW
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CONTRACTOR (PRINT) NAME 0 CONTRACTOR'S SUP VISOR (PRINT)
STREET ADDRESS e6 o 7 if SI URE
cl- g�2 pa DATE
TOWN STATE ZIP INSP I ED BY TOWN
Q 6o - , $2� �� DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER
F
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 #—�`
Street No. Street Name
Premises owned by:_;
Name of Firm: Phone:
Address of Firm:
TYPE OF WORK:
Lay House Drain Repair House Drain
La Main
Y ; Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with S
Existing Water Supply: Public Water Well
Proposed Start Date Voe Estimated*time for completion
ALL WORK TO BE IN ACCORDANCE WITH TOWN OF SOUTH WINDSOR STANDARDS,
ALL OSHA REQUIREMENTS AND CONDITIONS ATTACHED T97THE PERMIT
Permit is to be issued to JXin JcC0-UeS the holder of Drain
Layer's License No. a09 y ly the
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: �ct�oQS
s rain Layer
Date:
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc