HomeMy WebLinkAboutDrain Layers Permit 39 Copper Ridge vvvVJ/
PENT NUMBER TOWN OF SOUTH WINDS OR,R, CT
DATE: 07/22/08 DRAIN LAYER PERMIT
GIS ID:23500039
MUMS APPLIC
ATION# 200801106 :<
w<. �
F E E:
�:�•<�>: ...:... : E
00EXPIRATION DATE•APLICAN o808NAME: J COS
7sco LOCATIONADDREss: C
MMERCE WAY 3 COPPtR RIDGE
SOUTH WINDSOR, T€IO hk RSMLI CO iNC
4 17�4 PHONE ELL O;GTON RD
860-528525 $ 7x OI TS WSOR,CT 06074
f
WORK DESCRIPTION: NEW SEVEI
w
THE DRAIN LAYER ASSIGNED TO
T HIS'PE
M.,....
'. . >
THE TERMS AND CONDITIONS SET FORTS TICS �SITEIY
THE TOWN OF SOUTH WINDSOR STAND IiE T TI STT TE AND HEREBY AGREES TO ALL
S 11V�S' 1 „W0, Ac'L :' r ATTACHED
BE IN ACCORDANCE WITH
ACHED CONDITIONS.
ISSU D BY tw.:.,;r:
7/22/2008 11:24 AM DA PECTED
Of—
INSPECTED BY
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: ®003-7 CONTRACTOR:
LOCATION:_ 39 co popr j a
TYPE OF WORK: 2 Wee-
DATE
INSP NEEDED: DATE INSP:
INSPECTED BY: �
WORK IN
PROGRESS:
f-/o�•f' w O Jo ns� Dii� CwnXQ A r r S
r/
;V'\ 3114 �e r .,5 Ise � 9 I ����� e=•-.� � �,,i.��-�a� ��P�
I I O 1 J� �4i1�S �,�Sed b Apr (�ovt c7'i'\u 4'0 7 Ile SCH q 0
AS-BUILT: t/
INPUT: DATE: �` D
W/2007 Town of South Windsor INPSECTION REPORT 07
Yoe,-M,'Y# garJ 3
APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
a 00 60 I/06 PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $60.00
Location of proposed work: 3 C,U 6
L�� 2— �� of #
Street No. Street Name
Premises owned by: 12,5�-
Name of Firm:_ Phone: Z� Z �
Address of Firm: 7cs
TYPE OF WORK:
Lay House Drain X ; Repair House Drain
Lay Main ; Lay Lateral for Commercial/Industrial
Building of acres
a/
Connection will be made with 0!�
Existing Water Supply: Public Water_ Well
Proposed Start Date 75�� 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 o, ��- 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 aqj ppched thereto. Applicant has received
Town Street Excavation Permit No. and/or ConnDOT Permit No.
CBYD No.
Signed: Print Name: Jo?,,O�Ge-,l c �i -r'�
WZTicensecd Drain Layer
stam8rd.Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc
TOWN OF SOUTH WINDSOR
SANITARY - SEWER LATERAL 'FIELD LOCATION
DATE OF CONSTRUCTION. 21 V`
BUILDING ADDRESS oe 11"Ae
STREET . ` 9 � =°�f.
L
SUBDIVISION: Pt `
NORTH ARROW
rr
J J
i M ,
>t
ti
S
e — j
0
All
� 3
CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPERVISOR (PRINT)
STREET ADDRESS SIGNATURE
z 17�)RAJE
TOWN _ . STATE ZIP INSPECTED BY TOWN
DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER