HomeMy WebLinkAboutDrain Layers Permit 25 Stone Crossing TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 7619 Contractor WILCOX , MICHAEL (EAGLE)
Location $&ING Address EAGLE EARTHWORK SERV .
Type Work NEW "SAN LA1' 101 N MOUNTAIN ROAD
CANTON CT 06.019
o. (860)693-2027
Date Insp Needed 4" s 9to 3
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Time Insp Needed ��' 30
Inspected By
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Date
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7619 Town of South Windsor , CT
Permit pate 04/08/2003 Drain Layer Permit
Expiration Date 05/08/2003
Descrip:
Applicant Location
Name WILCOX, MICHAEL 402 STONE CROSSING
Addr . EAGLE EARTHWORK SER A INO BLDRS INC
101 N MOUNTAIN ROA ,
CANTON CT 0
Phone_ No. (860)693-2027 ;
The Drain Layer a nai s a d cense issued by the
state and hereby agre nd s set forth in the
attached 'Conditions' &Qp with Town of South
Windsor standards, all ached conditions.
Issued By
Date Inspected s{ By
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS
STREET : c
+ SUBDIVISION:
NORTH ARROW
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CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPERVISOR (PINT)
STREET ADDRESS SIGNATURE
_<N S tIC DATE
TOWN STATE ZIP INSPECTED BY TOWN
DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER
TOWN OF SOUTH WINDSOR
SANITARY SENER LATERAL FIELD LOCATION
DATE OF� CONSTRUCTION: C)
BUILDING ADDRESS
STREET
SUBDIVISION.
NORTH ARROW
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C RACTOR (PRINT) NAM F CONTRACTOR'S SUPERVISOR (PRINT)
STREET ADDRESS, SI f A AT U E
C- ` DATE
TOWN STATE ZIP INSPECTED BY TOWN
�" CS DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER
APPLICATION76(9
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: 25� D'yJ�C► -SSi�� Lot *
Street No. Street Name
Premises owned by: ki 5
Name of Firm:4 46,k to� ((�Q4C4 Phone:
Address of Firm: �� `1��n�^`f ���,��a,'����f Id'1'J
TYPE OF WORK: '
Lay House Drain ; Repair House Drain
Lay Main '
Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with �� }0✓4as gv r6 �'�6
Existing Water Supply: Public Water- X Well
Proposed Start Date—'±y Estimated time for completion /y
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 Mi Ld,leo x the holder of Drain
Layer's License No. Z7 8//6 Only holders of P1 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.
4
Signed: W Print Name: C k 0 `
W�
Licensed Drain Lay r
Date: 1-8-o
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIr.doc