HomeMy WebLinkAboutDrain Layers Permit 99 Tumblebrook Drive Permit No. 8078 Town of South Windsor, CT
Permit Date 07/28/2006 Drain Layer Permit
Expiration Date 08/27/2006
Descrip: INSTALL SEWER LATERAL'
Applicant
Name JAMES THROWE $dS 4fl9 TUMBLE 8I2bOIC. DRI
Addr. VANS SEWER & SEPTIC "
OW.n''er ANDERSC3N: NF}4L'P & `:;CAROL P
97 RIVERSIDE DRIVE;r
VERNON CT _OF06C�
Phone No. (860)289-0096.,
The Drain La s:` `Y">;'
Layer ass geed tk s s bat has a x+aY' d l'C*ons a sued by the
..
state and hereby agree tci. x;1;1':.;.the'"Eerm's aritl c'iYzdit. nS, t;:,forth in the
attached Conditionsx ..'AI1 work sfia3 - in :aeodrdanc with Town of South
Windsor standards, all: OSIA` ee;ure ' 2s; ait3' ,k>e atta'c>hec:>..co
.:.;;..;..:, :. ndi t i on s.
Issued B
Date Inspected
p ------------------- Insp'��t'ed:::::�y —
TOWN OF SOUTH WINDSOR INSPECTION REPORT
Pe..mit do. 8078 Contractor"RAM ES THROWE
Location OO" �It� bift - Ikddres VAN$.-SNWER & SEPTIC
Type Work NEW SAN LAT 9Z RIVERSI SE,-DR'I:VE
»:
VjRNON ;CT..,060.66
:
Phone,.NF.
o { 60�289 0095
Date Insp Needed ------____-- — Date Tnsp d04
Time Insp Needed 'ap
____________
-- —
Inspected By
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Work in Progress _ $il'0(D_ Cch cats:
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In ut Date
TOWN OF SOUTH WINDSOR
.SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS
STREET
SUBDIVISION:
NORTH ARROW L1eon oc.7�-
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CONTR-A-7CTOORR (PRINT) NAME OF CONTRACTOR'S SUPERVISOR (PRINT)
ILI
STREET ADDRESS S TURE
C.1 � �1 d fe 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 WINDSOR, CT
FEE $60.00
Location of proposed work:�_J__.......jam , l
- x Lot #
Street No. Street Name
Premises owned by: A I
ti
Name of Firm:
Phoned 7 CCU IS
Address-of Firm:
TYPE OF WORK:
Lay House Drain._ Repair House Drain
Lay Main � • Lay-Lateraf for Commercial/Industrial
Building of acres
Connection will be made with J s S-
Existing Water Supply: Public Water Well
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Proposed Start Date I
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 _. th
Layer's License No. -p - the holder of Drain
will be issued.a Only holders of P-1, P-7 or W-9 licenses
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.
Town Street Excavation Permit No. Applicant has received
and/or ConnDOT Permit No.
CBYD No.
Signed: Print Name:
+. L11=ce=n�sed Drain Layer
Date: a C)
Standard Forms\Permits\APPLICA170N FOR DRAIN LAYERS PERMrr.doc