HomeMy WebLinkAboutdrain layer permit 83 Northview Drive 900057 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
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DATE: 09/28/09
GIS ID: 64500083a:' S<:_
v FEE: 60.00
MUNIS APPLICATION# 200901172
EXPIRATION DATE: 10/28/09
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APPLICANT'` " yz " ^ LOCATION
NAME: ROTO ROOTER <r A :-vl-: :>D : :; :.<'::..'f l �y A 4 R $3 NORTHVIEW DRIVE
ADDRESS: 800 MARSHALL PFffiQ p s .:: :: &Pj3 ALBERT YOLANDE
BUILDING#25 lNORTRVIEW DRIVE
WINDSOR,CT 06045 QTTFfi WINDSOR,CT 06074
PHONE 860-721-9509 r y4Q
WORK DESCRIPTION: REPAIR$E*-E
THE DRAIN LAYER ASSIGNED TO THIS I?2EI ¢I 'HAS A � B ISSN B Tli`STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORD 1V FIF A 'ACI7�:� F �I�'IIS ;ALL WORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STAND AiR AEI✓C.S t : (u 1VT ,ANI `TF3E ATTACHED CONDITIONS.
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ISSUED BY DATE INSPECTED INSPECTED BY
9/28/2009 9:11 AM
INSPECTED BY: 9-';b
WORK IN
PROGRESS: P_OikCdd� Rw+"
c1'c' i,J'�d'� (� �� Pv_ S 2 35: Fran 31-L--6 +0
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SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT: 61�_�
INPUT: DATE:
W/2007 Town of South Windsor INPSECTION 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:_ Wor+ v i Cam/ D a Lot #
Street No. Street Name
Premises owned by:
Name of Firm: o= j a P� Phone: o 9-9-3-15 9 3
Address of Firm: _tea iMarSNNwj pl c NE �,i,i,cAs rnr
TYPE_ OF WORK:
Lay House Drainer Repair House Drain_��
Lay Main : Lay Lateral for Commercial/In u� strial
Building of acres
Connection will be made with ;jncco s,o(Z 3S
Existing Water Supply: Public Water Well
Proposed Start Date cl- o�j Estimated time for completion -3:ooem I-a- r•09
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. 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. 4 m o 0 59
Signed: 0��—Print Name: � o't�-
Licensed Drain Layer
Date:
Standard Forms\Permits\APPUCATION FOR DRAIN LAYERS PERMrr.doc
TOWN OF SOUTH WINDS0R
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: $ l �
BUILDING ADDRESS
STREET NZA Vle-L 3 'br v,e
SUBDIVISION:
NORTH ARROW
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CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPERVISOR (PRINT)
810-0
STREET ADDRESS SIGNATURE
GS 6\4 c�S:s v` cam g DATE
TOWN STATE ZIP INSPECTED BY TOWN
3 l DATE
TELEPHONE NUMBER
WHITE -'TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER