HomeMy WebLinkAboutdrain layer permit 1535 TOWN OF SOUTH ANDSOR
SANITARY SEWER LATERAL 'FIELD LOCATION
DATE OF CONSTRUCTION:
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A�CTO(RR (PRINT} NAME OF CONTRACTO ,S SUPERVISOR (PRINT)
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TOWN STATE ZIP INSPECTED BY TOWN
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TELEPHONE NUMBER,
WHITE - TOWN PINK - CONTRACTOR YELLOW- - CONSULTING ENGINEER / DEVELOP6
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: _1.5�'s 5 v l ),ve'n 4 v--,-- Lot #
Street No. Street Name
Premises owned by:
Name of Firm: l 4, Senz, kl-L Phone: aV_
Address of Firm: 9
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-.20-MAY 05 Estimated time for completion 49A Y G
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. a.G,;?-b�< . 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. ��o 'J&0
J
Signed: Print Name: ,m�s 1��i rel v/_L�
Licensed Drain Layer
Date:
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: CONTRACTOR:
LOCATION:
TYPE OF WORK:
-DATE INSP NEEDED: DATE INSP: p
INSPECTED BY: ej) _
WORK IN
PROGRESS:_ I
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DATE:
W/2007 Town of South Windsor INPSEMON REPORT 07
900025 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER
DRAIN LAYER PERMIT
DATE: 05/19/09
GIS ID: 87301535 C '
MUNIS APPLICATION_# 200900509 � '"*` ' '`f , FEE: 60.00
� # 4, � r K Y EXPIRATION DATE: 06/18/09
APPLICAN f £
NAME: JAMES THROWED A� e ` :TLOCATIO N
-a 3 SUI!LIVAN AVENUE
ADDRESS: 97 RIVERSIDE DRIE ZIDORA S L/U
VERNON ROCKVIL
S.ULEIVAN AVENUE
PHONE s rrTNDSOR CT 06074
860-289�Ob9 nyr '
WORK DESCRIPTION: INSTALL S-AI` E ^x
LATE
THE DRAIN LAYER ASSIGNED TO THIS s
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AyE T
' WIW " SSU 3 TEE. 'TATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FOR ( «. : .
N
AI LpZK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STAND ARI S;A�I
C? I ` TS ANT)"I$L`ATTACHED CONDITIONS.
ISSUED BY DATE INSPECTED INSPECTED BY
5/19/2009 9:00 AM