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TOWN OF SOUTH WINDSOR INSPECTION REPORT 'GP
Permit
No. 8115 Cont>r'actor;KESS. ER" TTSTRUCTION CO.
Location 61 71 TAd "g 5 '>k-;
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Type Work NEW SAN LAT
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Permit No. 8115 Town of South Windsor, CT
Permit Date 11/14/2006 Drain Layer Permit
Expiration Date 12/14/2006
Descrip: INSTALL SANITARY LAT121AL/ ry
Applicant L"ea,r`-ion
....c '::..i ':. !": {".yam.,,..i:;.r,.:..T•,`'; i.
Name KESSLER CONSTRUCT ON Co I"::....;...a •':•' ^°
'� .....', �T�'�w>:.5;�„-:7x1<;T�:MA�;A�I�':�A VE
Addr. 244 PROSPECT AVE T`FE57YLES CENTERS
O�,zle`r +POAG MC: L],Fy.
Q::
HARTFOR €. S%D
Phone No. 860 2 - u
a' or';y
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Th
e Drain
La er s � n
u�I-d by the
state and hereby agree:< he"fie' f'::' ffns'"aift`'cf§ tt.y ?.t.ss " `t ;forth in the
attached 'Conditions', s€, Tovn of South
Windsor standards, all .. .::• .d:..;
OSH axe i�'evgAt; t<satxd: ke ^atta' lieM:.;cox�clitions.
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Issued By \ 1 ". `
Date Inspected — ----------- T'n's' et��"`'By ���
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APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $60.00
Location of proposed work: 6 L--71 TAKAa-`k- AA Lot #
Street No. Street Name
Premises owned by: ,
Name of Firm:&Law .(� G � /� Phone: �1
Address of Firm: � i� ig�
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 4 t6 Estimated time for completion
ALL WORK TO BE IN ACCORDANCE WITH TOWN.-,OF SOUTH WINDSOR STANDARDS,
ALL OSHA REQUIREMENTS AND CONDITIQINS ATTACHED TO THE PERMIT
Permit is to be issued to 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(36 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.
Signed: l ar Tint Name:
Licensed Dr Laye
Date: A7 /
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc
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TOWN OF SOUTH ANDSOR
; SANITARY SEWER LATERAL :FIELD LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS
STREET ' � �
SUBDIVISION:
NORTH ARROW
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al- 40
i
ell
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CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUP SOR (PRINT),.
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STREET ADDRESS ` GNATURE
7�o DATE
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TOWN STATE ZIP INSPECTED BY TOWN
,903 33
DATE
TELEPHONE NUMBER
WHITE - TOWN PINK CONTRACTOR YELLOW..- CONSULTING ENGINEER / DEVELOPER