HomeMy WebLinkAboutDrain Layers Permit 134 Brook Street 900021
PERMIT NUMBER TOWN OF SOUTH W I N D S O R, CT
DATE: 05/23/08 .,.�......:...
DRAIN LAYER PERMIT
GIS ID: 14400134
MUNIS APPLICATION# 200800740
FEE:
>' 60.00
RATION EXPI D
ATE:
0 6/2 2
08
A P L I C A N
NAME: TOTH CONSTRUCTION LOCATION
ADDRESS: 63 GOTTIER ROAD
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t SASS 134'BROOK STREET
LAND CT 06084QLLIS §HARON K
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WORK DESCRIPTION: NEW SE*� LATL ' fi
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O THIS�:PERMh�..
THE TERMS
AND CONDITIONS S � ' I� '�:1'`�TAE :'
ET FORTH ITTA b .<. :STATE AND HEREBY AGREES TO ALL
THE TOWN OF SOUTH WINDSOR STANDARL?S AEIS3AR
t1ONS'2' 1LI VV<R SHALL BE IN ACCORDANCE WITH
< T AND I IIE ATTACHED CONDITIONS.
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ISS ED BY
5/23/2008 3:10 PM DATE" 1'ETED
ECTED BY
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: 50cc2s1 CONTRACTOR: IcTr l 66-jr 10- VACA,)l 6,,';,-(Z
LOCATION: ST-1
TYPE OF WORK: L C,,j jg c7mI
DATE INSP NEEDED: DATE INSP: 27 oS
INSPECTED BY:_ J�p
WORK IN
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W/2007 Town of South Windsor INPSEMON REPORT 07
111,111 tell] ' n 2 1 1 '
I OWN,i k I I CAI L
• 0919412AA-
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• �' APPLICATION FQ&D LAYER PERMIT
?ao eoa
A 14 0 U TOWN WINDSOR
PP PUBLIC W DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $60.00
Location of proposed work: Lot #
Street No. Street Name
Premises owned by: T( V-1- } 1 c 5 5 Zg0 j
d6-emje"oTf �6'a7ao7
Firm: �� Pho ?
Address of Firm: l9
TYPE OF WORK:
Lay House Drain ; Repair House Drain
Lay Main ; Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with
Existing Water Supply: Public Water Well V'
Proposed Start Date Zt 0 9S Estimated time for completion l Z3 o
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 _ 1 ��a— . the holder of Drain
Layer's License No.PLyv\ D zo S �-o"1 -P7. 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.
CBYD No. 0 1 -zoo �2
Signed: Print Name:_
Licen d Drain Layer
Date: l'
Standard Forms\Permits\APPLICATiON FOR DRAIN LAYERS PERMrr.doc
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