HomeMy WebLinkAboutDrain Layers Permit 35 Stone Crossing TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 7655 Co�1.:r&cto.r WILCO%;"M:ICHAEL (EAGLE)
Location 0035 STONE CROSSING . Add ':`"::EAG1-M ARTHWGRK SERV.
Type Work NEW SAN LAT _O1,.N:_.MbUNt ATk ROAD
;AN TON:.CT...;.0 6'019._ "<>
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Time Insp Needed �� �� Time ITit tv
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Permit No. 7655 Town of South Windsor, CT
Permit Date 08/01/2003 Drain Layer Permit
Expiration Date 08/31/2003
Descrip:
Applicant LQ�aton
Name WILCOX, MICHAEL €EAGLFI CrSSING
Addr. EAGLE EARTHWORK SERV. C7iw eX KNUREK:.RO.BERT N &:.JOAN E
101 N MOUNTAINROATI '
CANTON CT 66019
Phone No. (860)693 2zkx
Z7
G
The Drain Layer:assigiaed this � y� A ' �3d 1eense ''issued by the
state and hereby agrees' to � 1;the erms and ct�SxcTxtion9 se. oth in the
attached 'Conditions' . All VOT sha1� -11.. �t3zdan 0i.th Tovan of South
Windsor standards, a quiremnt , nd bhe atached::•conditions.
Issued By Title
Date Inspected ------- Inspec'ted By --
TOWN OF SOUTH WINDSOR
SANITARY , SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS : l
STREET ct
+ SUBDIVISION:
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CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPERVISOR (PRINT)
STREET ADDRESS SIGNATURE
O �/r��-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 " Cfo��,
STREET : `tom.. � l2
SUBDIVISION:
NORTH ARROW
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CONTRACT (PRINT) NA CONT CTOR'S SUPERVISOR (PRINT)
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STREET ADDRESS
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6 ►T/ / , �-�' t 1� i�2.r..�a DATE
TOOWyN/�n /'q STATE ZIP INSPECTED BY TOWN
DATE
(LEPHOK-E
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 $60.00
Location of proposed work: �� �`vr
� Lot # t
Street No. Street Name
Premises owned by: 4 /del m) bu;lde6
Name of Firm: f'A_6-k 0-7 )57 A-AriVW6 41< Phone: §9 zoei 7
Address-of Firm: El61
.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 d
Proposed Start Date 2)" Estimated time for completion -5
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 e the holder of Drain
Layer's License No. 27&1lo 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.
t
Signed: W Print Name:_ A0Aae(
Licensed Drain Laye
Date:
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc