HomeMy WebLinkAboutdrain layer permit 5280unk Lawrence Road 800063
"PERMIT PERMIT NUMBER TOWN OF SOUTH WINDSOR, CT
DRAIN LAYER PERMIT
DATE: 11/18/08
GIS ID: 528099 99 R . ` FEE:MUNIS APPLICATION# 200801830 °'` ;#. _ `. 00
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s.: ,. ,. EXPIRATION DATE:
_.. ..•.r ,s. s `�;.. <>k. 12/18/08
APPLICA .... ," " " .Y' - x <. `>°:
N ...w,..:,..:; t ` LOCATION
NAME: GERBER CONSTRUC TION o-'—'::": �.
.,. �,:. DRE `.:...,:.,�sA� CE ROAD
.ADDRESS: 1 NUTMEG DRIVE
,, �ywl � ' �. SOUTH WINDSOR
ELLINGTON,CT 06 y O SUI IVAN AVE
°. INDSOR CT 06074
PHONE 860-87 -664,4 .n ^- '
WORK DESCRIPTION: 07-805 IAWh %u
SEWER
TI AWRE CE RO
THE DRAIN LAYER ASSIGNED TO THIS>=.PER III r.S V° 'y
1�I F,�I SUF,�I� Y 1ATE AND HEREBY AGREES
THE TERMS AND CONDITIONS SET FOR"I T
A. jbNK W 'kK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDA ... SP, I;`OO. T IJFATTACHED CONDITIONS.
'
ISSUED BY DATE SPECTED INSPECTED BY
11/18/2008 2:55 PM
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: cxc&3
CONTRACTOR: C r Ip0 A
LOCATION: 6-�-7- .4
TYPE OF WORK: ,per
-DATE INSP NEEDED: DATE INSP: h 23 d
_ ^ INSPECTED BY:__I ___
WORK IN
PROGRESS: 1 w PCs �5 4-
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INPUT. DATE:_ - U 9
SCA.NNED
W/2007 Town of South Windsor INPSECTION REPORT 07
' APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
�Pp aX801g30 PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $60.00
Location of proposed work:
Street No. Street Name
Premises owned by: —rBL'o n a I A O(SD rr
Name of Firm:_ (�� �-��4�, 4 toe 1 rl c Phone:
Address of Firm:__ I L�� e►ti� ((�„g o aD c?
TYPE OF WORK:
Lay House Drain ; Repair House Drain ;
Lay Main ✓ ; Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with 8
Existing Water Supply: Public Water Well V
Proposed Start Date // 1 v Estimated time for completion &4n . e-7
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 ; 1e r t older of Drain
Layer's License No. ab k5 74 Only holders of P-1 P-7 r W79 Licenses
will be issued a permit. PERMIT WILL EXPIRE THIRTY (30 AYS 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. __ ab0g -lq D /&D
S C
Signed: Print Name: b
License rain Layer
_ Date: y M?
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Starldard.Forms\Permits\APPUCATION FOR DRAIN LAYERS PERMIT.doc
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