HomeMy WebLinkAboutDrain Layers Permit 206 Buckland Road (3) 800030 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 06/26/08
GIS ID: 15300206
MUNIS APP FEE: 60.00
LICATION# 200800959 :`°` .' `.
°>> EXPIRATION DATE: 07/26/0 8
AP PL I CA NT
LOC AT I O N
NAME: :
SIMSCROFT ECHO FARMS"� '>
FITCKLAND ROAD
ADDRESS: P O BOX 581
f, R :JNSEVILLE MARRION&ROY TRUST EES
MSBU RY CT
060 70€
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WORK DESCRIPTION
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1I�>THE DRAIN LAYER ASSIGNED TO THISRMIT` IA >"' ``;" ." `..
I� �is. 7BD THE STt TE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORTH III; FI '>A TA `C D NS1., ,Wb :SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOJ STANDAS;ATL aTX" ?IT 'z1D TH ' TACHED CONDITIONS.
ISSUED BY DATE SPECTED INSPECTED BY
6/26/2008 12:00 PM
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: 000 CONTRACTOR: vro
LOCATION:_2d /n A�
TYPE OF WORK: &4p w7 rn
DATE INSP NEEDED: DATE INSP: l
INSPECTED BY:�'►1
WORK IN
PROGRESS: ' n c%a✓ " Yo
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AS-BUILT:
INPUT: DATE:
W/2007 Town of South Windsor INPSECTION REPORT 07
APPLICATION FOR DRAIN LAYER PERMIT P&W i
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, Cr
FEE 160,00
Location of proposed work:
Street No. Lot #
Street Name
Premises owned by: n
t �
Name of Firm:
-Phone:
Address.of Firm: L,
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
Proposed Start Date mated time for completion '�I— a—0
P (8
All WORK TO BE IN ACCORDANCE WITH-TOWN OF SOUTH WINDSOR STAND
ALL OSHA.REQUIREMENTS AND CONDITIONS ATTACHED TO THE PERMIT STANDARDS,
Permit-is to be issued to
layer's License No the holder of Drain
� -= �0 4� Only ho ders of P-i, 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?Ob
Signed L
Print Name:Licensed Dra yer
Date'
Standard Forms\PermitS\APPLiCATION FOR DRAIN LAYERS PERMIT.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD : LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS -au-m&LojQr�
STREET
SUBDIVISION: PaL,ft,�,L
NORTH ARROW n yb e�G
C
v w V
CONTRACTrrOR (PRINT) NAME OF CONTRACTOR'S SUPERVISOR (PRINT)
STREET ADDRESS SIGNATURE
+M5��24 C t �.�_ DATE
TOWN STATE Zip /2222
INSPECTED BY TOWN
DATE
TELEPHONE NUMBER
WHITE — TOWN PINK — CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER