HomeMy WebLinkAboutdrain layer permit 170 Diane Drive 800069 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER
DRAIN LAYER PERMIT
>>
DATE: 01/07/09
GIS ID: 28200170
MUNIS APPLICATION# 200900006 FEE: 60.00
EXPIRATION DATE: 02/06/09
APPLICANT LOCATION
NAME: SKIPS SEPTIC ADDRESS 170 DI1NE DRIVE
ADDRESS: 27 MUDDY BROOK ROAD
ELLINGTON,CT 002} W1VRIIMAISKI PATRICIA A
x ? 'K0 f�IA1E DRIVE
PHONE 860-87$- 32 atIIIVINDSOR,CT 06074
WORK DESCRIPTION: NEW SW ;WA
THE DRAIN LAYER ASSIGNED TO THI PE �`'
1�SV' SSUI)I3I' F< TATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FO
THE TOWN OF SOUTH WINDSOR STAND T � ' ` I `' ` TO .;W"RK SHALL BE IN ACCORDANCE WITH
I�ATTACHED CONDITIONS.
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ISSUED BY
1/7/2009 8:15 AM DATE INSPECTED INSPECTED BY
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: 0 0
. CONTRACTOR:
LOCATION: I -) 0 1"> 1 0. V-)
TYPE OF WORK: zq VeA a.P
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--_---= -DATE INSP NEEDED: DATE INSP:
INSPECTED BY: B D
WORK IN
PROGRESS:_
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AS-BUILT:
INPUT: w- DATE:_1'3o °Q
W/2007 Town of South Windsor INPSECTION REPORT 07
APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
a , d,00900406 PUBLIC WORKS DEPARTMENT
r TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $60.00
Location of proposed work: �' 0 01�N C %Z Lot #
Street No. Street Name
Premises owned by: J e FF cS' f'
Name of Firm: "Sk I'P S �'���e— Phone: a 7 SZ 33 2.
Address of Firm: CJ • 470 2 g - �'.Z l nl 6-70 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 PVC S P iZ
Existing Water Supply: Public Water X Well
Proposed Start Date 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 -rO714 IWILkC the holder of Drain
Layer's License No. z u ? 1) 26� . 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. C as '� 0 / 0 /0 8^D
Signe Print Name: %77�d-5
Li ensed Drain Layer
Date:
&tandard.Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc
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