HomeMy WebLinkAboutDrain Layers Permit 111 Lavender Lane 800054 TOWN OF SOUTH WIND
PERMIT NUMBER S O IZ, C T
DRAIN LAYER PERMIT
DATE: 10/09/08 s
GIS ID:52600111 Y:«
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LICATION# 20080158560.00
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THE DRAIN LAYER !Y:ti: v >�1 ,<=a::,;,
ASSIGNED TO THIS�'I'ER1�4.I'f'���i3�:�"� ' 'I)'.:•: :: :.:
THE TERMS AND CONDITIONS SET FOR'ISIi.: :`:.y ` '•4" HE '1-3- 114.0 SPATE AND HEREBY AGREES
THE TOWN OF SOUTH WINDSOR STAND S# I T? 'Ct-NVTTlONS•':"'�`A �o SHALL BE IN ACCORD TO ALL
ARAS T;I:e3 •A•: ACCORDANCE WITH
*dTS ANTS:: HtLTTACHED CONDITIONS.
ISSUED BY '�`''�>:��'�.."'���•r., ::<:,, . �
10/9/2008 3:36 PM DATE INSPECTED INSPECTED BY
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: t—,5CONTRACTOR:
LOCATION:
TYPE OF WORK:_ �s�
-DATE INSP NEEDED: DATE INSP: i%Y bl
INSPECTED BY: Qt)
WORK IN -
PROGRESS: sure
AS-BUILT: 1/
INPUT: DATE:
W/2007 Town of South Windsor INPSECTION REPORT 07
perm t # 600d S
APPLICATION FOR DRAIN LAYER PERMIT
: d00801.5 65 TOWN OF SOUTH WINDSOR PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, Cr
FEE $60.00
Location of proposed work:/ LxL0 �!/� Lot # _
Street No. Street Name
Premises owned by:
Name of Firm:_ S(f�L'2111� Phone: '��� ""
Address of Firm: S� 't4
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 3 S
Existing Water Supply: Public Water Well
Proposed Start Date O 8 Estimated time for completion
ALL WORK TO BE IN ACCORDANCE WITH TOWN OF SOUTH WINDSOR STANDARDS,
ALL OSHA REQUIREMENTS AND CONDITIONS ATT CHED TO THE PERMIT
.Permit is to be issued to ® C: tJc�- �' S' the holder of Drain
Layer's License No. -908&3y . Only olders of P-1, P-7 or W79 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.
r
.Signed: Print Name:
Ll se in Layer
-.. Da 0 O
: : Standard:Fo \Perm \APPLICATION FOR DRAIN LAYERS PERMIT.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: U e5 cl t-o 6 ex a®
BUILDING ADDRESS t 3
STREET
SUBDIVISION:
NORTH ARROW
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CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPS S` IV OR (PRINT)
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STREET ADDRESS SIGNATURE
DATE
TOWN ` 4 STATE ZIP INSPECTED BY TOWN
(F4 b ) Aga a'"� 6 oZ� DATE
TELEPHONE NUMRER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER