HomeMy WebLinkAboutdrain layer permit Fox Meadow Lane 19 TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: CONTRACTOR:
LOCATION:
TYPE OF WORK:
--: DATE INSP NEEDED:
DATE INSP:
INSPECTED BY:
WORK IN
-PROGRESS:
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W/2007 Town of South Windsor jUpSEMON REPORT 07
900043 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 07/06/09
GIS ID:34200019 ::.,:•x;
FEE: 60.00
MUNIS APPLICATION# 200900758
EXPIRATION DATE:.ram 08/05/09
APPLICANT"
y:
PPL E...E I N
T LOCATION
NAME: SKIPS SEPTIC s f.. ` DRES 1§FOB 14EADOW LANE
ADDRESS: 27 MUDDY BROOK XQAV
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� FIAZELCIN TAN F&TRACT L
ELLINGTON,CT 060 9 } �'�,,k MEADOW LANE
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PHONE 860-875-02 xs p-
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WORK DESCRIPTION: NEW SEWEDKA L
THE DRAIN LAYER ASSIGNED TO THIS"PERM.-JT' IA A'a r UEI B T S ATE.AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORTH IN;%'fHE ATTA £ f# Nl.,; I T W:O SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDS AL C S A
ATTACHED CONDITIONS.
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7/6/2009 3:33 PM ISSUED BY D E PECTED INSPECTED BY
APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
a d4a9o075 PUBLIC WORKS DEPARTMENT
PP TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $60.00
Location of proposed work: /g °� £A-Z)rnJ 4 A Lot #
Street No. Street Name
Premises owned by:_ �z.gc `l 41-�jz C L W,�,1
Name of Firm: S <ys sF PTl c_ Phone: `�7 Z 3 3 Z
Address of Firm:
TYPE OF WORK:
Lay.House Drain ; Repair House Drain ;
Lay Main ; Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with 4 �'VC
Existing Water Supply: Public Water Well
Proposed Start Date �uEY u ? 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 the holder of Drain
Layer's License No. 20 1 1 z s 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.
Signed:.—/-/-
Print Name: 7�� wez_,&C1
Licensed Drain Layer
Date: 71-6 r 0 7
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMI.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: -7h 0
BUILDING ADDRESS _ �1
STREET
SUBDIVISION:
NORTH ARROW
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CONTRACTOR (PRINT) NAME OF C RA R'S PE SOR (PRINT)
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STREET ADDRESS SIGNATURE
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TOWN STATE ZIP INSPECTED BY TOWN
DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW ; CONSULTING ENGINEER / DEVELOPER