HomeMy WebLinkAboutdrain layer permit 254 Gerber Road East 900039 TOWN OF SOUTH WIND
PERMIT NUMBER S O R, C T
�} a` DRAIN LAYER PERMIT
DATE: 06/29/09
GIS ......
ID: 35110025
MUNIS APPLICATION# 200900733
t ` '' ?Y, > FEE: 60.00
EXPIRATION DATE: 07/29/09
APPLICANT
NAME: ASHE CONSTRUCTI6N.>L z"" t LOCATION
G` FRBR ROAD EAST UNIT 4
ADDRESS: 17 GRAMAR AVENiJ$, � �; � '• O�!�I� ;���MlTk0 REALTY GROUP
PROSPECT,CT 06712r s r � yECUTVE DRIVE
PHONE Ty, r> � 3 yJITF` 00
WORK DESCRIPTION: NEW SE� *CO'ATjc�lI,I
k
THE DRAIN LAYER ASSIGNED TO THIS ftRW"'� 1 A A
THE TERMS AND CONDITIONS SET FORTI. TTIE,tTC5�5L7 Y TIDE^STATE AND HEREBY AGREES TO ALL
THE TOWN OF SOUTH WINDSOR STANDARD} `'Y ; "` `„; ' .':'A IVRK SHALL BE IN ACCORDANCE WITH
*> OcSHA tIr�' ID:THE ATTACHED CONDITIONS.
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ISSUED BY 6/29/2009 12:31 PM DATE INSPECTED -----O�&-&SP�ECTED BY
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: CM39CONTRACTOR:
LOCATION:
TYPE OF WORK:__
-DATE INSP NEEDED: DATE INSP: 7
INSPECTED BY:
WORK IN
PROGRESS: Lov. duo r (a .Pvr
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AS-BUILT: v
INPUT: DATE: P 3 V 9
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
Location of proposed work: V-S Lot #
Street No. Street Name
Premises owned by: ONS`i )&TiOM
Name of Firm: Phone: _1) 15)50
Address of Firm:
TYPE OF WORK:
Lay House Drain ; Repair House Drain
Lay Main- -W ; Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made.with
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Existing Water Supply: Public Water V Well
Proposed Start Date tP 0 Estimated time for completion 23 b
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 _AWC ay kC-T- -A1 the holder of Drain
Layer's License No.RM • 02-7199q-0 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. 209 •- &0/&G
Signed: 1r wi::� Print Name: 49- kk,
Licensed Drain Layer
Date: 6 /01
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc
TOWN OF SOUTH WINDSOR
SANITARY- SEWER LATERAL FIELD : LOCATION
DATE OF CONSTRUCTION: r7 Z5 d
BUILDING ADDRESS 1PDInf 1a 4<�
-STREET
SUBDIVISION:
NORTH ARROW
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CONTRACTOR (PRINT) W44E' RACT SUPERVISOR (PRINT)
STREET ADDRESS: NN SIGNATURE //
C/�� Uti7 ...�. 7�8Aa I DATE
0 STATE ZIP INSPECTED BY TOWN -
G41 SD DATE
TE PHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING .ENGINEER / DEVELOPER