HomeMy WebLinkAboutDrain Layers Permit 2400 Tamarack Avenue 800049 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER
DRAIN LAYER PERMIT
DA E: 09/12/08
GIS ID: 8930240 ;s
MUNIS APPLICAT FEE:
ION# 200801423 60.00
9'j EXPIRA TION DATE
: 10/12/08
APPLICAN '" LOCATION
NAME: SIMSCROFT ECHO F;ARMS �
ADDRESS 2400 TAMARACK AVE.
ADDRESS: P O BOX 581 " 4ftE EVERGREEN MEDICAL ASSOCIATES LLC
SIMSBURY,CT 06010
2.0 <FSHE!R DRIVE
PHONE GT 06001
860 651. 3 v.
WORK DESCRIPTION: NEW SEEg
THIS IS A I' V4.: <. >:
THE DRAIN LA ,;; xx: <'N;
YER ASSIGNED TO THIS>'ERl1I1 `A its T Z> SSCJ
THE TERMS AND CONDITIONS SET FOR;'H 10"09fTHT` ' .„b �SKATE AND HEREBY AGREES TO ALL
� TLI rL.,' ILK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDARDS� rY4;jS. IAI iE E'N. T :;ATTACHED CONDITIONS.
ISSUED BY 9/12/2008 9:20 AM DATE INSPECTED INSPECTED BY
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: OUO CONTRACTOR:_ S i vy\s Cc
LOCATION: oZ q D® A-U
TYPE OF WORK:_ Seu).Q-A- Co v,r&c--l`,,0 jA -�a- e-tI IV �
DATE INSP NEEDED:
DATE INSP: / c�
INSPECTED BY: /.fib
WORK IN
PROGRESS: ion 1'iacdD✓ : '.., s � f Svc 517e
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AS-BUILT: LI---�
INPUT: C DATE: a
W/2007 Town of South Windsor INPSEMON REPORT 07
APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $60.00
M �
Location of proposed work: 'ZJoe -TAr*.-^VAc-K R vE Lot #
Street No. Street Name
Premises owned by:- IASL a 60RR
11Name of Firm: CASUe r.a Phone: 8��
Address of Firm: ZC0 R5095FL DA o AVPnT �I+ 6 01
TYPE OF WORK:
Lay House Drain ; Repair House Drain ;
Lay Main ; Lay Lateral for Commercial/Industrial
Buildings r of acres
Connection will be made with
Existing Water Supply: Public Water_ ' Well
Proposed Start Date _g Estimated time for completion
ALL WORK TO BE IN ACCORDANCE WITH TOWN OF SOUTH WINDSOR STANDARDS,
ALL OSHA REQUIREMENTS AND CONDITIONS ATTACHED TO THE P�RMIT
Permit is to be issued to / ! _ - ch d 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. '60 R-7dd - le�3
Signed: el i v ` .
9 Print Name: ),,t4f t L� � yf�'
-- - Licensed-Drain Layer- - -- - -
Date:
standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL 'FIELD
LOCATION
DATE OF CONSTRUCTION: 2— _ D
BUILDING ADDRESS : _ �Z `f(90
STREET —h:y
SUBDIVISION: C
NORTH ARROW
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CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPERVISO INT)
'a r—a YKs J, l 1 � ��.
STREET ADDRESS Sf TURE
TOWN STATE ZIP INSPECTED BY TOWN
(� 31 DATE
TELEPHONE NUMBER
WHITE — TOWN PINK — CONTRACTOR YELLOW — CONSULTING ENGINEER / DEVELOPER