HomeMy WebLinkAboutSanitary Lateral Street Cut Permits 18 W J
TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 6929 Contractor WILCOX, MICHAEL (EAGLE)
Location 0018 WELLES LANE Address EAGLE EARTHWORK SERV.
Type Work NEW SAN LAT 101 N MOUNTAIN ROAD
CANTON CT 06019
l PhOne, pro. (860)693-2027
Date Insp Needed �/ �� '� gate- ,In"sp.,
Time Insp Needed
Inspected By J. EZrJA
Work in Progress S)
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P� ,t, No. 6929
Pent"Date 12 02 1998 Town of South Windsor, CT
/ / Drain Layer Permit
Expiration Date 01/01/1999
Descrip:
Applicant Location
Name WILCOX, MICHAEL (EAGLE Add WELLES LANE
Addr. EAGLE EARTHWORK SERV. ,;. Qwner. BLOZZE REGINA M ET AL
101 N MOUNTAIN ROAD
CANTON CT G
Phone No. (860)693-2027
The Drain Layer assigl� d the pQ�1r!° 11 vald` license issued by the
state and hereby agres...tq� 1-� the °,� and c5lt, a► s set forth in the
attached 'Conditions' Al p shad l• t , .n adod, daric " with Town of South
Windsor standar s, a l rt €?SW1 rgimen and th+ attached conditions.
Issued Byre, "t
Date Inspect rL3 y3
TtlspeGt � •By Plt"/viG�
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: g
BUILDING ADDRESS : L 4 Z-
STREET
+ SUBDIVISION: ClibrKJejp
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CONTRACTO PRINT) NA E OF CO RACTOR'S SUPERVISOR (PRINT)
ST EET ADDRESS
SIGNA RE
3 DATE
TOWN qSA-TE ZIP 9
INSPEC D B TOWN
��6- ���� '' ' �)�� DATE
TELEPHONE NUMBER �-`�
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER
"✓ APPLICATION FOR DRAIN LAYERS PERMIT
TOWN OF SOUTH RTMSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE$25.00
Location of proposed work 18 0 s L°
� Lot #
Street No. Street Name
Premises owned by: &h It /,t-to
Name of Firm: Phone:
Address of Firm: o `o 1-1,
TYPE OF WORK.
Lay House Drain Repair House Drain
Lay Main ; Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with
Proposed Start Date fZ -.1 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 /�; �ia e �" ( �a X the holder of Drain
layer's License No. _ ;46 116 Only holders of P1, P7 & W9 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.
Signed: Print Name .�( j,( 4 Ank
Licensed Drain Layer !'
Date: