HomeMy WebLinkAboutdrain layer permit 141 Scott Drive 900072 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER - DRAIN LAYER PERMIT
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DATE: 12/07/09 't Ad
GIS'ID: 81600141 FEE: 60.00
MUNIS APPLICATION# 200901486 _ EXPIRATION DATE: 01/06/10
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APPLICAN LOCATION
NAME: HOMEOWNER -RE �: 1: 1 SC DRIVE
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ADDRESS: SOUTH WINDSOR, : 7 ,£ O JOHN A ETAL CO-TRUSTEES
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WORK DESCRIPTION: DISCONI TOJo
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THE DRAIN LAYER ASSIGNED TO THIS - ASS -�Y TATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FOR q,r"t C RK SHALL BE IN ACCORDANCE WITH
TH$,.TOWN OR SOUTH WINDSOR STAND A I�A �S ': n A ATTACHED CONDITIONS.
ISSUED BY,: DATE IN PECTED INSPECTED BY
12/7/2009.11:25 AM
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT" NO.: 9000 7 a CONTRACTOR: 1-l0meO(-O k►-efZ
LOCATION:
TYPE OF WORK: 1�i s c o h�Pc Se�e p, Pe 7 d U S
DATE INSP NEEDED: DATE INSP: Z La
INSPECTED BY:
WORK IN
PROGRESS: ('. ! �4w� E s
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SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: C 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: j SCQ=01-t , Lot #
Street No. Street Name
Premises owned by: v 0 U n v 5r4
Name of Firm: Phone:_6 g 9 1&-0 0
Address of Firm: h
TYPE OF WORK:
Lay House Drain ; Repair House Drain
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 l
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. rD lA and/or ConnDOT Permit No.
CBYD No.
Signed: Print Name: a rl re Ye,►2.U O�U
Licensed Drain Layer
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Date:- �
Standard FormsWermitsNAPPLICATION FOR DRAIN LAYERS PERMIT.doc
TOWN OF SOUTH WINDSOR
SANITARY - SEWER : LATERAL..�, 'FIELD . LOCATION
DATE OF CONSTRUCTION: ®9
BUILDING ADDRESS
STREET
SUBDIVISION:
NORTH ARROW
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CONTRACTOR (PRINT) . NAME OF CONTRACTOR'S SUPERVISOR (PRINT)
STREET ADDRESS SIGNATURE
-
TOWN g
STATE ZIP INSPECTED BY TOWN
DATE
TELEPHONE NUMBER
WHITE - TOWN" PINK - CONTRACTOR
YELLOW - CONSULTING ENGINEER / DEVELOPER