HomeMy WebLinkAboutDrain Layers Permit 0126 Avery Street (2) 900056 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER
DRAIN LAYER PERMIT
DATE: 09/22/09 RIC.
GIS ID:077 FEE:
ze
'kf . �., F 60.00
MUNIS APPLICATION# 200901141 pa ''_ a.
p _ N� y . EXPIRATION DATE: 10/22/09
APPLICA
°' \LOCATION
NAME: SKIPS SEPTICrRY STREET
ADDRESS: 27 MUDDY BROOlio •f � A` NTERPRISES LLC
ELLINGTON,CT 0M r g0 L SIANA ST
n T2.
PHONE 860-87 233-21
WORK DESCRIPTION: NEWS ' �IS
THE DRAIN LAYER ASSIGNED TO TH SSE A s SS D'Ba TATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FOR ETAC T. S' LL RK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STAND ,dTL"0 A I�L TS ND I E ATTACHED CONDITIONS.
C� /rno ( to � � ��� �$ 0?
ISSUED BY,, DATE INSPECTED INSPECTED BY
9/22/2009 3:20 PM
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: 9b®D5
CONTRACTOR:__,lkiDs
.1
LOCATION: ` o2Cs Ay-efu S-f '1 S 'in yoct VICkQS
TYPE OF WORK:_ V\ S�euu,- f o r\
DATE INSP NEEDED: DATE INSP:
INSPECTED BY:
WORK IN
PROGRESS: L� ,
cte.�d 1
SEPTIC TANK PUMPED, SMASHED, FILLED QJ7 WITNESSED FryEs ❑ NO
AS-BUILT: 'tom
INPUT: C DATE: �'6
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: �2 �' Y S Lot 'I
Street No. Street Name
Premises owned by: &7Z&-C PO 6 E';�-
Name of Firm:_ sk��-s s� Phone:
Address of Firm: a • ��c �'� r.�1 G'7��/
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
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. 20 1-) '7 2 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. oG g 3 70 /4-c g
Sign Print Name: -777�fly ail �
Licensed Drain Layer
Date:
Standard ForrnS\Permits\APPLICATION FOR DRAIN LAYERS PERMrr.doc
- TOWN OF SOUTH WIN`DSOR
SANITARY - SEWER LATERAL FIELD . LOCATION
DATE OF CONSTRUCTION: --- �� �
BUILDING ADDRESSGE-
STREET
SUBDIVISION:
NORTH ARROW.
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CONTRACTOR (PRINT) NAME OF CO RACTOR' SUPERVISOR (PRINT)
STREET ADDRESS SIGNA R
I107,`I � b6d 7e j DATE
TOWN STATE ZIP INSPECTED BY TOWN
DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING .ENGINEER / DEVELOPER