HomeMy WebLinkAboutdrain layer permit 279 Lawrence Road TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: p2R CO R. �D
NTRA O .
LOCATION: k i Q,r\ ,
TYPE OF WORK: 1 v N CO U�
-=------ - DATE INSP NEEDED:D: DATE INSP: ,�E/_/ 9
INSPECTED BY:
WORK IN
.PROGRESS: �6y yycl cai 7- s G ~'/�✓C S�2 3
d r�K�ibK TAP ^ 5ew�, -Aft_/_
mid
AS-BUILT:
INPUT: DATE:
SCAA/A
FD
W/2007 Town of South Windsor INPSECTION REPORT 07
perm,*t #0 70000kc
APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
qj,p j aQO J'OO Y7J TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $60.00 e4o
Location of proposed work: Lot #
Street No. Street Name J
Premises owned by:
Name of Firmer , Phoneeg;� oz)
Address of Firm: ��.�f� iTG6f OLD S, ritii �'O 2 �l
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 y
Proposed Start Dat r-o Estimated time for completion _I
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 Z.) the holder of Drain
Layer's License No.0 A Off'3 A 3=27 . Only holders' 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.<�'ft a 6
Signed- Print Name: ��2
Licensed Drain Lay r
Date:
Standard Forms\Perm1ts\APPLICA710N FOR DRAIN LAYERS PERMIT.doc
TOWN OF SOUTH ANDSOR
�SANITARY SEWER LATE RALFIE-to_ LOCATION
DATE. OF CONSTRUCTION; '�A I 1
BUILDING ADDRESS - .4 Lnsa, Eel\C-e ra
-STREET
SUBDIVISION:
NORTH ARROW
s
ys ._
lZ C_ Tx-_tk6!cCC Iles
_ C
CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPE R (PRINT)
STREET ADDRESS SIGNATURE
DATE
�3C 1'T'C1 1,.�;3 \Y►1s�►�.9S.S Z.S1C��1 y� Z
TOWN STATE ZIP INSPECTED BY TOWN
DATE
TELEPHONE NUMBER
WHITE TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER