HomeMy WebLinkAboutDrain Layers Permit 43 Wildlife Trail (3) s 750024 TOWN OF SOUTH WINDSOR, CT
PERMIT NT?MBER DRAIN LAYER PERMIT
DATE: 07/06/07
GIS ID:94400043
FEE: 60.00
MUNIS APPLICATION# 200701041 EXPIRATION DATE: 08/05/07
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APPLI A C NT <::.L��>��' OCATION
INAME: FOLSOM CONSTRUCTOP :+ : ......; D FE TRAIL
ADDRESS: 138 RYE STREETis
�CRNER MEA
DOW LLC R
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SOUTH WINDSO Cf d507 .:'``'+":'•_ x1�1 II Y'IIILL DRIVE
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SO CT 06 UtH WINDSOR, 074
PHONE 860-528-$92�>
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WORK DESCRIPTION: NEW
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THE DRAIN LAYER ASSIGNED
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TO THIS+k,�F
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THE TERMS AND CONDITIONS SET FORTS INiL><La£TA15'.>Zvi HALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDAI )5 ALAI"F). HP .T ii lj THE.A34:ACHED CONDITIONS.
ISSUED BY DATE—M'SPECTED INSPECTED BY
7/6/2007 3:44 PM
TOWN - OF SOUTH WINDSOR
SANITARY SEWER : LATERAL RELD LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS 9,3
STREET c f, i
SUBDIVISION:
NORTH ARROW
_1 M. tnp
001
CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPERVISOR (PRINT)
STREET AD RESS SIGNATURE
SG U1 J�6 L G DATE
TOWN STATE ZIP INSPECTED BY TOWN
DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW — CONSULTING ENGINEER / DEVELOPER
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: 7S19oa
CONTRACTOR:
LOCATION:_ 7c3
TYPE OF WORK:
DATE INSP NEEDED: DATE INSP:
INSPECTED BY:
WORK IN
PROGRESS:
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AS-BUILT:
INPUT: DATE:
W/2007 Town of South Windsor INPSEC HON REPORT 07
APPLICATION FOR DRAIN LAYER PERMIT
JUBLIC
TOWN OF SOUTH WINDSOR
WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $60.00
Location of proposed work:±5 k1l 16 11. / iL Lot # '
Street No. Street Name
Premises owned by: Okk6e- RaI&4(j&6
Name of Firm:
/'� e �1�1 Phone:
Address of Firm: lok1l,1/ a e4
TYPE OF WORK:
Lay House Drai ; Repair House Drain
Lay Main ; Lay Lateral for Commercial/Industrial ,
Building of acres
Connection will be made with SO 1C S
Existing Water Supply: Public Water Well
Proposed Start Date"7 �l 4 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 torso-oAe C_o�'J4 U- the holder of Drai
n
am
Layer's License No. 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 and attached thereto. Applicant has received
Town Street Excavation Permit No. and/or ConnDOT Permit No.
Signed• el r Print Name: yyl�)�
'censed Drain Layer � ('7� io
Date: f- C/-Q 7
Standard Forms\Pennits\APPUCATION FOR DRAIN LAYERS PERMIT.doc