HomeMy WebLinkAboutDrain Layers Permit 303/304 Wentworth Pa Permit No. 7947 Town of South Windsor, CT
Permit Date 07/14/2005 Drain Layer Permit
Expiration Date 08/13/2005
Descrip: INSTALL SANITARY LATERAL a. <+
Applicant
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Name J & H SLATER CON;bT 'C6 y>.% � ()3 b4 W4#*TWORTH PARK
Addr. 75 COMMERCE WAY.' er GENE RA-T-A.ON'`12
SOUTH WIND SOR
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The Dra
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attached Conditions. }"ithgwn of South
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TOWN TOWN OF SOUTH WINDSOR.,.X--'SPE,Q.. IQX REPdn
Permit No. 79
47 on. r :cto-r' &`;H,..:: LATEt' CONS=.T CO
Location 303/304 WENTWORTH PARK, -i Address a
7 �CGMftt '6E WAY;:
Type Work NEW SAN LAT
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P _____ ____ Date
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL. MELD LOCATION
DATE OF CONSTRUCTION: 7' is_" 05-
BUILDING ADDRESS 0�` _ 3 a 6 �4kL aeo/
STREET
SUBDIVISION: l�e�i�wt�rrh �uyk
NORTH ARROW
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CONTRACTOR (PRINT) NAME OF CON CTOR'S SUPERVISOR` (PRINT)
STREET ADDRESS SIGNATURE
0607 7`!5'/tgATE
TOWN STATE ZIP INSPECTED BY TOWN
6� ,S'-ly 5`1 rL DATE
TELEPHONE NUMBER s
WHITE — TOWN PINK — CONTRACTOR YELLOW — CONSULTING ENGINEER / DEVELOPER
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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:—� 6-&L 4 PO RAC- Lot #
Street No. Street Name
Premises owned by: -Ttot� 2
Name of Firm: J 1�" (JL Phone: ? -SZ 2
Address.of Firm:_
TYPE OF WORK:
Lay House Drain______; Repair House Drain
Lay Main ; Lay Lateral-for Commercial/Industrial
Building of acres
Connection will be made withC.
Existing Water Supply: Public Water_ Well
Proposed Start Date I 6b— 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 d. Cq T the holder of Drain
Layer's License No. 2%1-Li2 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 d attached thereto. Applicant has received
Town Street Excavation Permit No. and/or ConnDOT Permit No.
CBYD N
Signe . Print Name:_ ,CAS . TiZ
Licensed Drain ye
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Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc