HomeMy WebLinkAboutdrain layer permit 239 Graham Road 900034 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBERmlftft�ftlDRAIN LAYER PERMIT
1
DATE: 06/19/09
GIS ID:37500239 "
MUNIS APPLICATION# 200900695 `« FEE: 60.00
EXPIRATION DATE: 07/19/09
APPLICAN OCATION
NAME: HERB HOLDEN TRUAM ROAD
.
ADDRESS: 59 BROAD BROOKAD, s 2 OR LUTHERAN CHURCH
BROAD BROOK,CT 6 AM ROAD
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PHONE @ SOP,CT 06074
WORK DESCRIPTION: NEW SE O "
THE DRAIN LAYER ASSIGNED TO THIS P t STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORTH
THE TOWN OF SOUTH WINDSOR STANDARDS, L ORK SHALL BE IN ACCORDANCE WITH
ry ,' E ATTACHED CONDITIONS.
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, ISSUED BY DA E INSPECTED INSPECTED B
6/19/2009 3:31 PM
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: f o
CONTRACTOR:_ Je7� t�/1
LOCATION: 13
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TYPE OF WORK: f e �e�
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-- - --DATE INSP NEEDED:
DATE INSP:
INSPECTED BY: �D `
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DATE:_ t q
W/2007 Town of South Windsor INPSECnON REpop
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APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL Q�
1540 SULLIVAN AVENUE ---
SOUTH WINDSOR, CT
FEE $60.00 C
Location of proposed work:(; �f {�-I Prw1 P Lot #
Street No. Street Name
Premises owned by: Oug- 51NV t oft- v-jjfei;2.Aj-Q CffV9Z0
Name of Firm: (NIZ hone: 6CO r-G 23 8
Address of Firm: % c ' 90, -�
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TYPE OF WORK:
Lay House Drain ; Repair Hous 'n ;
Lay Main ; Lay Lateral for ommercial ndustrial
Building of acres
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Connection will be made with
Existing Water Supply: (:Public Water 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 OhLf*4 -Di the holder of Drain
Layer's License No.`gd,&.1 3So - P-7 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. *aloac) /8o 3 5S
-s a3 7�o C� �
Signed: Print Name: d. "'i
Licensed brain Layer
Date: `f
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc
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