HomeMy WebLinkAboutdrain layer permit 232 Lawrence Road TOWN OF SOUTH WINDSOR INSPECTION REPORT
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WJ2007 Town of South Windsor INPSEMON REPORT 07
900044 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 07/06/09 � z z
GIS ID: 52800232 ems, s".,, FEE: 60.00
MUNIS APPLICATION# 200900759 n r °' k.",. ^',? :>...a EXPIRATION DATE: 08/05/09
APPLICANT,, `$ E' $ � Y LOCATION
NAME: SKIPS SEPTIC ' DRES2 AW;FENCE ROAD
ADDRESS: 27 MUDDY BROOK (J T;.IT ,RTON G&JEAN E
ELLINGTON,CT 06(�2 ,; A�; ,''.'' ..' 7$ WINCE RD
TV�NDSOR,CT 06074
PHONE 860-8752
WORK DESCRIPTION: NEW SEWVEIjt
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THE DRAIN LAYER ASSIGNED TO THIS�.'ERMIfi I �'Fk I UE Y Tw-S TE AND E O LL
THE TERMS AND CONDITIONS SET FORIIHI§A<IT .3 �- -I'ON ' f1I O SHALL BE IN ACC RDA ITH
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THE TOWN OF SOUTH WINDSOR STAND , LL n,SHA'; ' > F., TTACHED CONDITIONS.
COF MUM BY DATE INSPECTED INSPECTED BY
7/6/2009 3:59 PM
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APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
00900 �j PUBLIC WORKS DEPARTMENT
a pp1 a ,S TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $60.00
Location of proposed work: 0 3 z-- L47ilz e tic E Lot #
Street No. Street Name
Premises owned by: �' ��✓ �� i T
Name of Firm: �'A-- e-;P 5' S eIP-17C- Phone: 7 z 33
Address of Firm: ?- 0. goy 2—;' I CZ-e- r--/G7V
TYPE OF WORK:
Lay House Drain ; Repair House Drain ;
Lay Main ; Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with f w C
Existing Water Supply: Public Water Well �C
Proposed Start Date 11`�Y a 1 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 /,V kn-X-c/z the holder of Drain
Layer's License No.z-c ? 7 z 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. 2 4-0 .2 ¢aSC POW&
ANNEV
Signed: Print Name:
,J/
Li ensed Drain Layer
Date: 9-6 -0
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc
TOWN - OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS : 3
STREET
SUBDIVISION:
NORTH ARROW
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CONTRACTOR (PRINT) NAME OF CO CTOW UPERVISOR-(PRINT)
STREET ADDRESS SIGNATURE
_ 11 h 14 _. a DATE
TOWN STATE ZIP INSPECTED BY TOWN
DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER
TOWN - OF SQUTH WINDSOR
SANITARY S EW E R LATE RAL :,Fl E LD LOCATION
DATE OF CONSTRUCTION: 7' 2s-04
BUILDING ADDRESS «�
STREET
SUBDIVISION: v
NORTH ARROW
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35
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CONTRACTOR (PRINT} NAM CO CTOR'S SUPERVISOR (PRINT)
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STREET A(DDRE5S SIGNATURE
t i ( DATE
TOWN STATE ZIP INSPECTED BY TOWN
to.p $1,j3 3 2 DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING .ENGINEER / DEVELOPER