HomeMy WebLinkAboutdrain layer permit 67 Jacques Lane 900031 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER
DRAIN LAYER PERMIT
fi45,
DATE: 06/04/09 � if
FEE: 60.00
GIS ID:46500067
MUNIS APPLICATION# 200900608 j �{
' EXPIRATION DATE: 07/04/09
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APPLICAN LOCATION� � � ,
NAME: ROTO ROOTER S. ACQ ES LANE
ADDRESS: 800 MARSHALL PHL C 3 AN J&PAMELA B
BUILDING#2 3 ES LANE
WINDSOR,CT 06095 _h SOR,CT 06074 JTA
PHONE 860-727- 0 � �
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WORK DESCRIPTION: REPAIR S RtP
THE DRAIN LAYER ASSIGNED TO THIS P 11E ` . STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORTH L ORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDARD L` b=- E ATTACHED CONDITIONS.
ISSUED BY DATE INSPECTED INSPECTED BY
6/4/2009 10:54 AM
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: G1 was CONTRACTOR:
LOCATION:_ C��I ahcq ��po 5 L Y1 P
TYPE OF WORK: S
DATE INSP NEEDED: DATE INSP: Vae-7
INSPECTED BY-
WORK IN
PROGRESS: f 7 G t
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SEPTIC TANK PUMP D, SMASHED, FILLED lt.� WITNESSED El 4_ ❑ NO
AS-BUILT:
INPUT: DATE:
W/2007 Town of South Windsor INPSECTION REPORT 07
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I.DarjAr ME M11141
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MARTA
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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 work: ' /—�`
proposed Lot #
Street No. Street Name
Premises owned by:—., 0 �- i a ee
Name of Firm: AUv ��U� V Phone:
/ P
Address of Firm: ,5� �� /224 r S A
TYPE OF WORK:
-Lay House Drain S , Repair House Drain S ,
Lay.Main ; Lay Lateral for Commercial/Industrial
Building of acres
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
Jc��' he,e��� S
Permit is to be issued to the holder of Drain
Layer's License No. _ZU 3 3 3 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:l�'n-2(Z5 �
Li sed
Date: /� Drain Layer
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Standard Forms\Permlts\APPLICATION FOR DRAIN LAYERS PERMIT.doc