HomeMy WebLinkAboutDrain Layers Permit 55 Wildlife Trail Permit No. 7989 'Town of South Windsor, CT
Permit Date 10/26/2005 Drain Layer Permit
Expiration Date 11/25/2005
Descrip: INSTALL SANIT. SEW. -L'Ai TF A
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Applicant LC�d Lon
Name FOLSOM CONSTRUCTI'bN. LLC € dd 5Fa WII D:L.IFt RAIL:;
Addr. 138 RYE STREET 6o16Qr.,RIVERWJaK
SOUTH WIN DSOR
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Phone No. (860)528-8528 -- '
The Drain Layer assigned th�.s e�mx- has a va1j-d Itense &�ssited by the
tstate and herebY agrees-. o` ' `theterms`'a'ridcori`<Nl .:: •:;;.;::.> ;.
in the
attached 'Conditions' .. All wc5k shae axx aecordace witka Town of South
Windsor standards, all OSHA •reuiretn�xs
q t'i ar�d �1�e att'aclied;;coxiditions.
Issued By ------- --�i�l _ y Zitle'
Date Inspected -- I"rY' peeet°"gy
TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 7989 Con5Xaet8r FOLSO(N'° oNSTRUCTION LLC
Location 55 WILDLIFE TRAIL Adclre ^t 138 :g;XE �TRE°E:T
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Type Work NEW SAN LAT <
S0�7TH W'FNDI'OR:. CT_ 06074
Flaon ':Io �8fs )528 8928 -
Date Insp Needed
----------- D a t Tits p fZ
Time Ins Needed
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Inspected By ems' 1- df
Work in Progress `i
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Da't'e`
TOWN OF SOUTH ANDSOR
SANITARY SEWER - LATERAL fIELD.- LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS
STREETfCdf
SUBDIVISION: � ' `��
NORTH ARROW
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CONTRACTOR (PRINT-) NAME OF_CONTRACTOR'S SUPE�PRINT}
STREET ADDR� SI TURE
!-- ,ov Leg 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
r � c Location of proposed work. S �
S
Lot #�
Street No. Street Name `
Premises owned by:
Name of Frm:�—z�L� �S ��
Address-of Firm:
TYPE OF WORK:
Lay House Drain Repair House Drain
:
Lay Main ; Lay Lateraf for Commercial/Industrial
Building of acres
Connection will be made with
Existing Water Supply: ublic Water Well
Proposed Start Date /D - 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 ZUS-01-1 /yam
the holder of Drain
Layer's License No. Only holders of P-1, P-7 or W-9licenses
will he issued a permit. PERM 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.
CBYD No.
---------------------------
SigneAil
Print Name:
e.d rain Layer
Date:
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc