HomeMy WebLinkAboutDrain Layers Permit 51 Wildlife Trail Permit No. 7991 Town of South Windsor, CT
Permit Date 10/26/2005 Drain Layer Permit
Expiration Date 11/25/2005
Descrip: INSTALL SANIT. SEW. -ATER'AL
Applicant oe La.t'3. on
Name FOLSOM CONSTRUCTZflN LI�C ack � tII�DLIF tFP�IL:
Addr. 138 RYE STREET Ov7rer RIVERW13TxK
SOUTH WINDSOR �-07k
Phone No. (860)528-80 .'
The Drain Layer ss3gned -Chas a ttt has a u 1id license j.ssued by the
state and hereby a re -6t .r< `�'1 '.. he' t`— ms"azs` <""`
_.. '..
Y 9 :.: es, _ca. ._ ,t Co c�it:xc,ngr< et ;:forkh in the
attached 'Conditions' Tillaxk sha>1X::.:k zxi aeordanCe wztk TOFIn of South
Wind
sor standards all O SIiA ..e uirenlYCs;::=a'Yicl',.,.ki�i` atta' het7�::;,.cox'ditions.
Issued By ---- _1!
Date Inspected
~ TOWN OF SOUTH WINDSOR INSPECTION REPORT
_termit No. 7991 Cont :a 'tor FOLSOM "CQ.NSTRUCTION LLC
Location S1 WILDLIFE TRAIL
Type Work NEW SAN LAT SOU�F� WIN196OR Cri:-06074
Phone .No ($�o)S28 8�28
Y:.
Date Ins1' Needed /
---------------
Dat Zips # .
Time Insp Needed Iame- Iff
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Inspected By
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• TOWN OF SOUTH WINDSOR
.. SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: r° z -�►�
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BUILDING ADDRESS s/ w�L,�c�� ��,�•� v-�� �
STREET
SUBDIVISION:
NORTH ARROW
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CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPERVI OR (PRINT)
STREET ADDR SS SI TURE
r 4—lwll Leg c_T DATE
S
TOWN STATE ZIP INSPECTED BY TOWN
.S'acq-b 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: 1 �V/ Lot # � /
� .
Street No. Street Name
Premises owned by:
Name of Firm:_ a�_ o r-r D U�r '� Phone:&!
Address.of Firm: / -." I J didLZ (J 7
TYPE OF WORK:
Lay House Drain X Repair House Drain
Lay Main - '
y Lateral for Commercial/Industrial
Building of acres
Connection will be made with
Existing Water Supply: Public Water Well
Proposed Start Date to : Estimated time for completion
ALL WORK TO BE IN ACCORDANCE WITH TOWN OF SOUTH WINDSOR STANDARDS,
ALL OSHA REQUIREMENT-S-� AND CONDITIONS ATTACHED TO THE PERMIT
Permit-is to be issued tor�/.�M the holder of Drain
Layer's License No. Only holders of P-1, P-7 or W-9 licenses
will be issued a permit. P RMIT 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.
Signe �� Print Name:
s Dr in Layer
Date:
Standard Forms\Permlts\APPUCATION FOR DRAIN LAYERS PERMIr.doc