HomeMy WebLinkAboutDrain Layers Permit 15 Wildlife Trail ~ Permit No. 8034
Town of South Windsor, CT
Permit Date 03/16/2006
Expiration Date 04/15/2006 Drain Layer Permit
Descrip:
Applicant '
: r
Location
Name FOLSOM CONSTRUCTION LLC: 2kdtr 3LIVERWATK lTi�f"IT '17
Addr. 138 RYE STREET
SOUTH WINDSOR CT, OSt77$'
Phone No. (860)528-8928 :_'
The Drain Layer aseiigne<3 phis permit has a valsd .lxcen � issued by the
state and hereby agr�ds :to;all tieet� aY - QnC}it'xoris set .f.oth in the
attached 'ConditioYss' . Al yvor]{-"shall ' oorHax"Ce With ToU✓n of South
Windsor standards, 'all'OSHA .requix, mt the atacneci•-conditions.
Issued B
--------------------
Date Inspected
------------------- Inspected By._<=-------------
TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No 8p34 C L
Location
ont actor.F £SOM ONSTRUCTION LLC
°�ddre s
1; 8 RYE'STREET
Type Work T SWAN LA SO.UIH WINDSOR- 06074
2ss28
Date Insp Needed
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Time Insp Needed . a �o
Inspected By `
/� s7
Work in Progress _C�✓1 ✓rtG�i' a.s� r' 1-1
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Input - "Date
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD - LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS 1
STREET
t� SUBDIVISION: ��G / -✓���
NORTH ARROW
.. . ..........
24,
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1
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CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPERVISOR (PRINT)
STREET ADDRESS SIGNATURE
DATE
TOWN STATE ZIP INSPECTED BY TOWN
DATE
TELEPHONE .NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW CONSULTING ENGINEER / DEVELOPER
�03
APPLICATION. N 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: /S ��
Lot#
Street No. Street Name
Premises owned by:
Name of Firm: e/ ,�
Phone: J_ e
Address.of Firm: 1.;;�q
TYPE OF WORK:
Lay House Drain Repair House Drain
Lay Main
Lay-Lateral-for Commerdal/Industrial
Building of acres
Connection will be made with S'®4e
Existing 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 License 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 terms
-and conditions set forth in the permit and attached thereto.
Town Street Excavation Permit No. Applicant has received
and/or ConnDOT Permit No.
-CBYD No.
Signed: Print Name:_ /a —��o .r
Licensed Drain Layer
,Date: 3
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc