HomeMy WebLinkAboutdrain layer permit 404 Rye Street TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL .FJELD LOCATION
DATE. OF CONSTRUCTION: � Ay
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CONTR/A-CTOR (PRINT} NAME OF CONTRACTOR'S SUPERVISOR (PRINT)
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TOWN STATE ZIP INSPECTED BY TOWN
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TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACT6� YELLOW - CONSULTING ENGINEER / DEVELOPER
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: y0,1 LL S Lot #
Street No. Street Name
Premises owned by: � I'
Name of Firm: Qs �-AA4,r + o ,c �;r^yi t1LC Phone:
Address of Firm:_ `3? Pyers,I j �✓r or)
TYPE OF WORK:
Lay House Drain ; Repair House Drain ;
Lay Main ; Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with N,Te- OJI gf, C,,jjSC?ING 1.V
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Existing Water Supply: Public Water Well X AID%f-s-r Fw- u' )
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Proposed Start Date Estimated time for completion rU
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 _J�Yrt.�� �k the holder of Drain
Layer's License No. Q09 6,9 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. ;)007 )�Ro �Soz
Signed: Print Name:
9 � ►^�
0 Licensed Drain Layer
Date: /Z �M)41Y(3 i
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT-NO.: CONTRACTOR.,
LOCATION: O e
TYPE OF WORK:
--DATE INSP NEEDED: DATE INSP: i g a�
T INSPECTED BY: Bpi
WORK IN
PROGRESS:_
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AS-BUILT.,-
INPUT., DATE:
W/2007 Town of South Windsor INPSEMON REPORT 07
900022 TOWN OF SOUTH WINDSOR CT
PERMIT NUMBER ,
DRAIN LAYER PERMIT
DATE: 05/14/09
GIS ID: 78600404E
MUNIS APPLICATION# 200900497fi �' � � FEE: 60.00
fit' ,. ' ,> yk,,:j' v A "^s'vC. ,.
DATE:' } s; f / .�4 y} EXPIRATION 06/13/09
LOCATION
NAME: JAMES THROWE D A<• f4 T ADDRESS: 97 RIVERSIDE DRI C RYE BEET
VERNON ROCKVII11,GEORGE W
4 RYA STREET
PHONE 860-28009 �' r NDSOR CT 06074
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WORK DESCRIPTION: INSTALk SA E "xj LRA
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THE DRAIN LAYER ASSIGNED TO THIS E T `A k '
f: ISU :TTATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORT�•II�f"CIE�'P� �" �;���SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDAISq ",pg
�� .Q A ATTACHED CONDITIONS.
ISSUED BY DATE INSPECTED INSPECTED BY
5/14/2009 12:04 PM