HomeMy WebLinkAboutDrain Layers Permit 34 Stone Crossing i
TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 7654 Contra or WILCbX'»:4;CHAEL (EAGLE)
Location 0034 STONE CROSSING Address ;':> EAG.tE BARTHWORK SERV.
Type Work NEW SAN LAT "" ""
N M`OUNTAIIV`ROAD
Phone I3o € 60J 69:3 2027
Date Insp Needed `T r�� vat e 'I:f a
Time Insp Needed Time In -
Inspected By -
Work in Progress
GQ q As Input -- = Date
Permit No. 7654 Town of South Windsor, CT
Permit Date 08/01/2003 Drain Layer Permit
Expiration Date 08/31/2003
Descrip:
Applicant LpCat` On
Name WILCOX, MICHAEL €EAGLB) Ad�it U4 STONE CF� $SNG
Addr. EAGLE EARTHWORI. SERV . OwYI:&r MANNAR.INO BLDRS INC
101 N MOUNTAIN ROAD
N.
CANTON CT% 06019
Phone No. (860)693-2;027
The Drain Layer assigned t tis 3s4rj Yr�3'd license' zssued by the
state and hereby agree:* ';to 11>.the terms and cohdaGiois set. okth in the
attached 'Conditions..". All. wcark Sha1Yeeoordance with Tcywn of South
Windsor standards, all OSHA Y£` uixemOnts. 1d -the attached--to ditions.
Issued By ------ Title
Date Inspected Inspected By ______—_
-------------------- -----------------
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS .e > `'
STREET
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CONTRACTOR (PRINT) NAME OF CONTRACTORS SUPERVISOR (PRINT)
STREET ADDRESS SIGNATURE
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TOWN STATE ZIP INSPECTED BY TOWN
DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL , FIELD LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS /1
STREET : S fro F a e05511fCg
SUBDIVISION: �� C
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CONTRACTOR (PRINT) NAME F NT CT O ' S P R I R (PRINT)
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,� PI DATE
TOWN 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
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WIN'DSOR, CT
FEE $60.00
Location of proposed work: "" d'j2 Lot #
Street No. Street Name Iq
Premises owned by: &nnal",010 a
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Name of Firm:_��-�-�.9 rA� w d2K, Phone:. (O Y 3 Z4Z7
Address.of Firm: I%Uo;to4in
TYPE OF WORK:
Lay House Drain K 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 (9 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 the holder of Drain
Layer's License No. 278/!(0 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.
Signed: �1�(l Print Name:
Licensed Drain Layer
Date:
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
1 '
DATE OF CONSTRUCTION:
BUILDING ADDRESS
STREET S �b rC
+ SUBDIVISION:
NORTH ARROW
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CONTRACTOR (PRINT) NAME OF CONTRACTORS SUPERVISOR (PRINT)
D/ ran .�
STREET ADDRESS SIGNATURE
a6 °/ ii �1 DATE
TOWN STATE ZIP INSPECTED BY TOWN
DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL , FIELD LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS / (i7
STREET : S ONO ae055J/fe
SUBDIVISION:
NORTH ARROW d
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CONTRACTOR (PRINT) f� ��/n gyp! NAME F NT CT O ' S P R I R (PRINT)
STRE DRE S A URE
Goa g n3 DATE
TOWN STATE ZIP INSPECTED BY TOWN
DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER
L
APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WIN'DSOR, CT
FEE $60.00
Location of proposed work: Lot #
Street No. Street Name
Premises owned by: &nna,-, `no hv'1 J g6
Name of Firm: A 9 T-6)VAK, Phone: 6/ J-ZOZ7
Address of Firm:_/O Nd/t uot f&'V(n
TYPE OF WORK:
Lay House Drain K Repair House Drain
Lay Main ; Lay Lateral for Commercial/Industrial-
Building of acres
Connection will be made with —A-
Existing Water Supply: Public Water_ Well
Proposed Start Date 8- Estimated time for completion �" 7
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 the holder of Drain
Layer's License No. 27811(O 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.
Signed: Ul fe
Print Name: � l ���� (�(Ji
Licensed Drain Layer
Date:
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc