HomeMy WebLinkAboutDrain Layers Permit 3 Wildlife Trail r
Permit No. 8102 Town of South Windsor, CT
Permit Date 10/17/2006 Drain Layer Permit
Expiration Date 11/16/2006
Descrip: INSTALL SANITARY LATERAL::; ::: "
Applicant
L oea t`'
ion
Name FOLSOM CONSTRUCTION LLCKX
dS1s-XW. 3 I4IkiALIFE T:321TL
Addr. 138 RYE STREET Osa2ier CORNER:
MEADOW LL4
SOUTH WINDSOR �T„'060F4"
Phone No. (860)528-8528.
Kg
The Drain Layer asss'gnc11. t.h�1S* �t his 3t 1�d l cens issued by the
state and hereby agree to7>1 .the'terms aY1d C'ci3dtz'bforth in the
attached 'Conditions a. A11 �aark sh b ,;A �cfr zn. e wst,$ ToWn of South
Windsor standardss,j all OSHA x4quire.mex:Cs atZa arhet ,co tciitions.
Issued By ----— C r�d•/�
-------- _ T1tl.
Date Inspected
TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 8102 Cont..ra<Ceor FOLS�:GQNSTRUCTION LLC
Location 3 WILDLIFE TRAIL
Aedress,> _` '138;'RY'E>°>STRE'E.T
Type Work NEW SAN LAT "
....:: SDQUTH RIND: OR C .. 06074
Phon ',1To (BSQ)528t'8928
Date Insp Needed w�l'�—CA!
bath
Time Insp Needed
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Inspected By
Work in Progress _ y� jAcTcf SSG fii �y 'b ` 1
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TOWN OF SOUTH WINDSOR
SANITARY,' SEWER LATE-RAIL ,FIELD - LOCATION
DATE OF CONSTRUCTION:
01
BUILDING ADDRESS
STREET
t
SUBDIVISION:
NORTH ARROW
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IV/
1 •
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CONTRACTOR (PRINT) ' NAME OF CONTRACTOR'S SUPERVI NT
STREET ADDRESS SIGNATURE
��'i,��'•�'�,��,� ili�Z�r�t�I 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:
• � � Lt� I
Stre efi No. Lot #
Street Name
Premises owned by:
Nam of Firm: OZ.,SOc low
4 ePhone:
Address.of Firm: l-3rr
TYPE OF WORK:
Lay House Drain Repair House Drain
Lay Main • Lay-Lateral-for Commeraal/Industrial
Building of. acres
Connection will be made with c ��
Existing Water Supply: Public Water Well
Proposed Start Date 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
I
Permit is to be issued to ® oN
Layer's License No. a holder of Drain
Will be issued.a Only holders of P-1, P-7 or W-9 licenses
permit. PE MIT WILL EXPIRE THIRTY(30)ZAYS 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 N069vv ' —• Z-Oz' l-t
Signed-
Print Name: kc, SEO/
i sed Drain Layer
Date:
Standard FOrms\Permits\APP(ICgnON FOR DRAIN LAYERS PERMIT.doc