HomeMy WebLinkAboutDrain Layers Permit 24 Stone Crossing TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No.
Contractor WILCOX MICHAEL (EAGLE) it
Location kh A0441-00#
., Address EAGLE EARTHWORK SERV. j
Type Work NEW SAN LAT 101 N MOUNTAIN ROAD
CANTON CT 06019
n No. (860)693-2027 j
Date Insp Needed I t�
Time Insp Needed
Inspected By
Work . in Progress
t Date
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Permit No. 7583 Town of South Windsor, CT
Permit Date 09/25/2002 Drain Layer Permit
'Expiration Date 10/26/2002
Descrip:
Applicant Location
Name WILCOX, MICHAEL A t STONE CROSSING
Addr. EAGLE EARTHWORK S NARINO BUILDERS
101 N MOUNTAIN R
CANTON
Phone No. (860)693-20
The Drain Layer Rt; ha license issued by the
state and hereby a re ad a one set forth in the
attached 'Co nditio i nce with Town of South
Windsor standards, e i die ttached conditions.
Issued By
Date Inspected ed By
_
TOWN OF SOUTH WIN DSOR
SANITARY _ SEWER LATERAL FIELD LOCATION
9 5ZV7 DATE OF CONSTRUCTION.
BUILDING ADDRESST
STREET
+ SUBDIVISION: P,i0E�,
NORTH ARROW
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CONTRACTOR (PRINT) r NAME OF CONTRACTOR'S SUPERVISOR (PRINT)
STREET ADDRESS SIGNATURE
c _1l DATE
TOWN STATE ZIP INSPECTED BY TOWN
&G !:�,2 �,�'� 1 DATE
TELEPHONE NUMBER
WHITE — TOWN PINK — CONTRACTOR YELLOW — CONSULTING ENGINEER / DEVELOPER
TOWN OF SOUTH WIN�DSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: ✓
BUILDING ADDRESS 0,Po55�, NG
STREET
SUBDIVISION:
NORTH ARROW
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CONTRACTOR (PRINT) NAME DF CONT CT B:S SUPERVISOR (PRINT)
(7 eL24
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S EET' ADDRESS SIGNATURE
060( 2,/� SATE
TOWN C� STATE ZIP INSPECTED 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
h TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $60.00
Location of proposed work: 's Lot *
Street No. Street Nam
Premises owned by:.& 40,14e�16 L-/de�s
Name of Firm: Ce A"6(101'k Sqe Phone: 65 2oz7
Address of Firm: l01 gom Auy yltiao �lri
TYPE OF WORK:
Lay House Drain D�e ; Repair House Drain ;
Lay Main ; Lay Lateral for Commercial/Industrial
Building of acres
u
Connection will be made with 50r� �lC�
Existing Water Supply: Public Water X Well
Proposed Start Date 2�Z5T 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 A 6ctlze V,(Co K the holder of Drain
Layer's License No. Only holders of Pi or P7 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.
L
Si9 ned: Print Name: G� Ok
Licensed Drain Layer
..e
Date:
Standard FormsWermitMAPPLICATION FOR DRAIN LAYERS PERMIT.doc