HomeMy WebLinkAboutDrain Layers Permit 27 Wildlife Trail $t�rmit No. 8122
Town of South Windsor, CT
Permit Date 11/28/2006 ,. ......::.
Expiration Date 12/28/2006 Drain Layer Permit
Descrip: INSTALL SEWER
Applicant
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Addr. 138 RYE STREET
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SOUTH WINDS OR
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Date Inspected
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
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Permit No. 8122 Corl;;,,-r'actcr,.FOLSQM `OpNSTRUCTION LLC
Locatio 2% WILD11Fs TRAIL ;�l!d e
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Type Work NEW SAN LAT
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TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD - LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS : a ` 1
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SUBDIVISION: � �►' �
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CONTRACTOR (PRINT) NAME' F ONTRACTOR'S SUPERVISOR (PRINT)
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STREET ADDRESS SIGNATURE
S��` �b � �� CT �� 9/�,� DATE
TOWN STATE ZIP INSPECTED BY TOWN
DATE
TELEPHONE NUMBER
WHITE - TOWN PINK — CONTRACTOR YELLOW — CONSULTING ENGINEER i DEVELOPER
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APPLICATION FOR DRAIN LAYER PERMIT
} TOWN OF SOUTH WINDSOR
` PUBLIC WORKS DEPARTMENT
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TOWN HALL
1540 SULLIVAN AVENUE
49.r SOUTH WINDSOR,CT
FEE $60.00
Location of proposed work:
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Lot# .
Street No. Street Name
Premises owned by: Oa,14 e
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Name of Hrm;
�.-w� iJv► Phone: °-SZ� Z
Address:of Firm: 3 S�yl
TYPE OF WORK:
Lay House Drain
O' ._,' Repair House Drain
Lay Main • Lay_Lateral*for Commeraai/IndusWa-
Building of.
acres_
Connection will be made with IpVC
Existing Water Supply: Public Water Well
Proposed Start Date Estimated time for completion -
AIL WORK TO BE IN ACCORDANCE$NITH TOWN OF SOUTH WINDSOR STANDARDS,
ALL OSHA'.REQUIREMEI'M AND CONDITIONS ATTACHED TO THE PERMIT
Permit Is to be issued to
Layer's License No. the holder of Drain
wilt be issued.a . Only holders of P-1,P-7.or W-9 licenses
permit: PERMIT WILL E3CPIRE THIRTjt(30)'DAYS AFTER
DATE OF ISSUANCE. The undersigned Drain Layer.hereby agrees to all the terms
and condt4ons set forth in the Permit and a ttad�ed thereto.
Town Street Excavation Permit No. Applicant has received
and/or ConnDOT Permit No,
CBYD No.
Signed: ` Print Name:
Ltcens Dr in Layer --�ry""�
Date: I/
standard Ferms\Per"ts\APPLtCA-ION FOR DRAIN LAYERS PERMIT.doc . .