HomeMy WebLinkAboutdrain layer permit Frazer Fir Road 78 900028
PERMIT NUMBER TOWN OF SOUTH W I N D S O R, CT
DRAIN LAYER R PERMIT
DATE: 05/20/09
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GIS ID:34430078
MUNIS APPLICA �;`�'+� �� :..3„A y;'�"}h rY•� �'
TION# 200900537 E> w" vv `'•'
FEE:
60.00
k EX
PIRATION
P I RA T O N
DA
TE:E•
A PPLIC 06/19/09
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NAME: EAGLE � `�F �>'�. 5.�::;t :>.•:..��:. �-.:.,.;>`V,`
EARTHWO ::. ... y ..:::.......:<Y ` .;:.LOCATION
ADD RRR :.:. ::: < .. ' ;
10 N MOUNTAIN ,;f<` �RAZ
ADDRESS: MOUNT R FIR ROAD
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CANTON, CT 06019 h &� ' NO BUILDERS INC
< s # y y t r t 69 ELLINGTON RD
PHONE
860-6932b27 T 060743515
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WORK DESCRIPTION: f
INSTALlf
THE DRAIN LAYER ASSIGNED TO THIS'k?`Rw "r£ X
THE TERMS AND CONDITIONS SET FORTE '
BSSU1J:; Y TIE.STATE AND HEREBY AGREES TO ALL
THE TOWN OF SOUTH WINDSOR STAND3N ' LC2K SHALL BE 1N ACCORDANCE ARCS,A ID:pBnF 'I S,A IE'ATTACHED CONDITIONS. NCE WITH
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ISSUED BY 5�:::;�,1>.�••>:,d; .,f: ,::.;:;.k �
5/20/2009 12:51 PM DATE INSPECTED
INSPECTED BY
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: 2o00A:E CONTRACTOR:
LOCATION:_ -7Y F t
TYPE OF WORK:
DATE INSP NEEDED: DATE INSP: S ZI (fig
INSPECTED BY: D
WORK IN
PROGRESS:
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AS-BUILT:
INPUT: DATE: _I G 0 [I
W/2007 Town of South Windsor INPSEMON REPORT 07
A^, Zook 37 rrr 9�Z8
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: / � �Ya'Z�'er �'!' Lot # l
Street No. Street Name
Premises owned by:_ )%0t if 0`r-?�r a d ur, e'S'
Name of Firm:-- = _ 1�o rz-C Phone: X0
Address of Firm:LB/ ko-k/-A 1"'A.
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 1Estimated 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 `G1� �e. GUi�`GoX the holder of Drain
Layer's License No. _,;z,77T1cOnly holders of P-1, P-7 or W7.9 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.
Signed. rint Name: i [4,ev(
Licensed Drain Layer
Dater
Standard forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc
TOWN OF SOUTH WhNDSOR
SANITARY . SEWE R LATERAL FIELD LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS : 7 Le 10
r STREET • �-► z'e �'� 1�
SUBDIVISION: �' -
NORTH ARROW
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AOL
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CONTRAMRR (PRINT) c NAME Of CONTRACTOR'S SUPE S R (PRINT)
SIRE-ET ADDRESS ? S TORE
DATE .
TOWN STATE ZIR -� INSPECTED BY TOWN
DATE
TELEPHONE NUMBER
WHITE - TOWN PINK CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER