HomeMy WebLinkAboutDrain Layers Permit 4 Copper Ridge 800066 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 12/03/08 ;>< "
GIS ID:23500004 rf FEE: 60.00
MUNIS APPLICATION# 200801904 EXPIRATION DATE: 01/02/09
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APPLICANT LOCATION
NAME: J&H SLATER CONST CO ADDRE :.. COPPER RIDGE
ADDRESS: 75 COMMERCE WAV1 .',` C NER K-KEi LC0 INC
SOUTH WINDSOR,CT3b(I74 1744 ELLNGTON RD
PHONE O[JTI;I VVINDSOR, CT 06074
860-528 1252
WORK DESCRIPTION: NEW SEWED LATIAL CtNNETI01+ ,.,;
THE DRAIN LAYER ASSIGNED TO THIS PERIkIITHAS A V L 'ISSUED'BY'1HE STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORTH IN THE ATTAI3EI�` [NT7IIION ALL WORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDARDS,AI L OSHA I E EME". ANC TH1'ATTACHED CONDITIONS.
ISSUED BY DATE INSPECTED
INSPECTED BY
12/3/2008 11:54 AM
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: ("a o ( C CONTRACTOR: Tv
LOCATION:_ Li
TYPE OF WORK:
DATE INSP NEEDED: DATE INSP: r /Y
INSPECTED BY: 4)
WORK IN
PROGRESS:
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AS-BUILT:
INPUT: C'VVV
DATE:_
W/2007 Town of South Windsor INPSECFION REPORT 07
f er m,I # ��1J0d 66
APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
0 TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $60.00
Location of proposed work: Ll C1 Lot #
Street No. Street Name
Premises owned by: /24
Name of Firm: /WSLA_62 Phone:
Address of Firm:_ 7
TYPE OF WORK:
Lay House Drain_; Repair House Drain
Lay Main ; Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with 6<t /lSG
Existing Water Supply: Public Water_ Well
Proposed Start Date /Z 0L Estimated time for completion 2
ALL WORK TO BE IN ACCORDANCE WITH TOWN OF SOUTH WINDSOR STANDARDS,
ALL OSHA REQUIREMENTS AND CONDITIONS ATTACHED TO THE PERMIT
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Permit is to be issued to IC'L the holder of Drain
Layer's License No. t5'�-7 f 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. "a � �«��
Signed: f�� �j Print Name: , / g/
icensed Drain Layer
Date.
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: ' ' '
BUILDING ADDRESS __:____ �� -' t � °x.� �: Xa
STREET
�-�- SUBDIVISION:
NORTH ARROW
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CONTRACTOR (PRINT) NAME OF COIN T C OR'S SUPERVISOR (PRINT)
STREET ADDRESS SIGNATUR
DATE
TOWN STATE ZIP INSPECTED BY TOWN
DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER f DEVELOPER