HomeMy WebLinkAboutDrain Layers Permit 23 Wildlife Trail Permit No. 8123
Permit Date 11/28/2006 f..,.::....: Town of South Windsor, CT
Expiration Date 12/28/2006 Drain Layer Permit
1� INSTALL SEWER LATERA
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Applicant
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Name
FOLSOM CONSTRUCTIO
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Addr. 138 RYE STREET
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SOUTH WIN DSOR
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,., filycstan t Tti wn of South
Windsor standards, all:. 0 S H " "'"' "` ''` sN<^«n`'
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Date Inspected
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit-No. Core: 'ctor,FOLSOM"CbW.STRUCTION LLC
Location 23 WXLl3IAIFS *rAAT;L &fd a ;.138 Y 'ST Eh`T..
Type Wofk NEW SAN LAT .,H WTNf1 i0. CTk:,.06074
Pfi ogre'.'..N:ca.`;4.8 rS 218
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Date
Ins Needed
e Insp Needed
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Time T'tee. ':,
Inspected
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TOWN OF SOUTH WINDSOR
SANITARY - SEWER LATERAL FIELD LOCATION
DATE. OF CONSTRUCTION: 11 hi 1 04:
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BUILDING ADDRESS : a a 7 /-Ji�cla l` `t"2Af �.
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STREET : r✓ _• tit- )9 q lo,'erct
SUBDIVISION: � �� �
NORTH ARROW
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Folsom
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CONTRACTOR (PRINT) NAME: F ONTRACTOR'S SUPERVISOR (PRINT}
STREET SIGNATURE
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TOWN STATE ZIP INSPECTED BY TOWN
DATE
TELEPHONE NUMBER
WHITE -.TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER
6123
APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
W - PUBLIC WORKS DEOARTMENT
TOWN HALL.
1540 SULLIVAN AVENUE °
2. SOUTH WINDSOR, CT
FEE $60.00
Location of proposed work: 3 LW fe ccv/
Lot # 7r
Street No. Street Name
-Premises owned by: d
Name of arm: vvt
Phone.
Address:of Firm: fdv
TYPE OF WORK:
Lay House Drain Repair House Drain
.Lay.Main . .
Lay.Lateral-for Commerdal/Industrial
Building of. acres
Connection will be made with /1).c/C
Bdsang 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
Permit Is to be issued to
Layer's Ucense No. 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 term
-and conditions.set forth in the permit and s
attached thereto.
Town Street Excavation Permit No. Applicant has received
and/or ConnDOT Permit No.
-CBYD No.
Signed. •
Licensed Dr ' Layer tint Name:__ c
Date:
Standard Forms\Pemdts\APPUCAT10N FOR DRAIN LAYERS'PERMIT.doc . .