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HomeMy WebLinkAboutDrain Layers Permit 19 Wildlife Trail Permit No. 8033 Permit Date 03/16/2006 Town of South Windsor, CT Expiration Date 04/15/2006 Drain Layer Permit Descrip; 60.00 CASH Applicant 1'i n P t P Location a: ' i o n Nam e e F O L S OM CO NSTRUCTION S T R UC T. I ON L . Addr. 138 RYE STREET RIS7ER�TA K nwrt�r SOUTH WINDSOR 06174.. Phone No. (860)528-6928:` The Drain Layer ass; ged.this pemt 4. WaXxd.I3cense issued by the state and hereby agrees to alb,. the tel -�csnditions set frit attached 'Conditions All tv©,rk h in the fie. scc?rdarice witk� T.iwn of South Windsor standards, ail 4SIA requ2remen c�nzA the attachd..ctinditions. Issued By �- ' Tz ------------------- Date Inspected ----------__--___ Inspect"ed B y sue.TOWN OF SOUTH WINDSOR INSPECTION REPORT Permit No. 8033 Co tf&c:tor FQLSQM CONSTRUCTION LLC Location 1 * _ ,I 9Y%`S'TREET Type Work NEW SAN LAT S.U WIhIDSd.R; CT_.. 06074 Phone.Ncs (B51128 8928 Date Insp Needed (p ------------ A. Time Insp Needed ime } *' fad► ------------� tip Inspected By Work in Progress rrom -- -- 1 �...� J. --��j����---`�`-"'�s-'�---�`--�---CG..�#Jam► t l�l�. ( 1 _ ` In ut p Date TOWN OF SOUTH WINDSOR SANITARY SEWER - LATERAL FIELD - LOCATION DATE Of CONSTRUCTION: BUILDING ADDRESS STREET : </®/' In SUBDIVISION: NORTH ARROW Tr _ I s — $ X i X �- �- i l ol Ile CONTRACTOR (PRINT) NAIVE OF CONTRACTOR'S S RVISOR (PRINT) 130 STREET ADDRESS- GNATURE DATE TOWN STATE_ ZIP INSPECTED BY TOWN Sa -y� f. 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, Cr FEE $60.00 Location of proposed work:- /�� Lot Street No. Street Name Premises owned by: Name of Firm: /Z�7 es,-;�Y.,� Phone: -'r- -6 1016 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 4, 3 r- Existing Water Supply: Public Water ''� Weil 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 tolr� g the holder of Drain Layer's License No. �a� �� Only holders of P-1, P-7 or W-9 licenses Will be issued.a permit. PERMIT WILL EXPIRE THIRTY(30)VAYS 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 an ConnDOT Permit No. CBYD No. Signed: P— � Licensed Drain Layer � Print Name: a _` - Date: rC Standard Forms\Permits\APPLICATTON FOR DRAIN LAYERS PERMIT.doc