HomeMy WebLinkAboutDrain Layers Permit 824 Pleasant Valley (2) 800026 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER
DRAIN LAYER PERMIT
DATE: 06/09/08
GIS ID: 72900824 `
MLTNIS APPLI "''x FEE: 60.00
CATION# 200800839
"'::
EXPIRATION D ATE:
07/09/0 8
A PP L I CA NT.�li f
NA ME:
JAMES LO CA TI N
ADDRESS: ;y; . '..` > .:<::. ...;P EASANT VALLEY ROAD
97 RIVERSIDE DRIVF{'
ASON J&VERA F
VERNON ROC KV ILL`
E
AS A NT VA
LL E
Y
II,,WT�DSOR'CT06 074PHONE 860-289-OOg.:�::;
�V I?.WORK DESCRIPTION: REPAIRHOLE :. :�N
.<
:
THE RAIN LAYER ASSIGNED TO THIS E
N�E: SLTED,$ fiIE, T.,ATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORTS„II ` IE'>1 TAG .jS ;?
THE TOWN OF SOUTH WINDSOR STAND AKpS''AIL,CbS3 . .. ",.a:: I: OR£SHALL BE IN ACCORDANCE WITH
.. I1* ,.,M39D HE'A'TTACHED CONDITIONS.
t
6/9/2008 1:24 PM ISSUED BY
DATE INp 'CTED INSPECTED BY
TOWN OE SOUTH WINDSOR INSPECTION RE
PORT
PERMIT NO.:
CONTRACTOR:
LOCATION:
TYPE OF WORK:
DATE INSP NEEDED:
� � `tr8
INSPECTED BY: DATE INSP:
WORK IN
PROGRESS:
•. � L�i'�iBQ; S PL 3b
d T_+
-----------------
AS-BUILT:
INPUT:
DATE:
W/2007 Town of South WrndsDr INPSECTION REPORT 07
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: q1"_ I
_Lot #
Street No. Street Name
Premises owned by:
v 11
Name of Firm: � + 'h '�evyi_� ,,UC Phone: ��6c
r))
Address of Firm:
TYPE OF WORK:
Lay House Drain ; Repair House Drain -�
Lay Main ; Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with S 6('P UZ 3s
Existing Water Supply: Public Water Well
Proposed Start Date c 11.✓V O� Estimated time for completion 1V Jur\Jc)T
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 the holder of Drain
Layer's License No. 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.
Signed:--/ Print Name:
Licensed Drain Layer
Standard.Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc
1 ►► 0 ! 1I ' ► N/ ! '
■ ■ +-�'►' ��� ■fir � ■ ��
■�� III � '� I ■r� � ■
■ �� III 1 ��� ■ ■ �i�
_, y