HomeMy WebLinkAboutdrain layer permit 1006 Sullivan Avenue TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No,. 7896 e.nt t WII COa§T}ZUCTION CO(DARRYL)
%
Location T EE C �A�e s O� AFF61kp ROAD
Type Work DIS SAN LATz . � T 6084`'.,
Date Insp Needed _L&A���w� I4 w e�Ins A „
Time Insp Needed
Inspected By
Work in Progress
.;a ;.
mod- C3�
Input ------------- Date --------------
r
Permit No. 7896 4 � Town of South Windsor, CT
Permit Date 04/04/2005 ?"tea.. Drain Layer Permit
Expiration Date 05/04/20054,3
: h`" ° .
Descrip: DISCONNECT & ABANq-dN c D166AN
Applicant
Name WILCOX CONS TRUCION.0 AR111) 06 jEVrYAI AVHNUE
Addr. 535 OLD STAFFOlb ROA EON�T) {1TT s.
TOLLAND CT Q6' ar 3yw.
Phone No. (860)871-43�ry�
r }
ank>fl
The Drain Layerass
,;gc � is x d se i sued by the
state and hereby ag e.. .t 4.:.rC _. y •,s sOt, th in the
attached 'Conditions . All``"go: ka.0. zi #,:' o da"i T& J th;, T. wn of South
Windsor standards, al' O FA e uik-t �W chhe Ctonditions.
0
i
n
Issued BY ��T.�.tle
Date Inspected ------ Inspected By ___________________________
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: \ o00 A \vo 5 �`. N Lot #
Street No. Street Name
Premises owned by:
Name of Firm:_ \ ^ Gv,,, Phone:g=g 1.9 ce-1/2oP-587/
Address of Firm:_ S 3 5-
TYPE OF WORK:
Lay House Drain Repair House Drain ;sc�e..
Lay Main ; Lay Lateraf for Commercial/Industrial
Building of acres
Connection will be made with
Existing Water Supply: Public Water V Well
Proposed Start Date_ 4-tl-o S Estimated time for completion 3�-v 5
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 the hnider of Drain
Layer's License No. Only holders of P-1 -7 r W-9 licenses
will be issued a permit. PERMIT WILL EXPIRE THIRTY(3 -- 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. _ 2ooStZo\\ 0
Signed: 'Print Name: /2!
Licensed Dram Layer
Date: *3 2-9-QS
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc
TOWN OF SOUTH WINDSOR
SANITARY - SEWER LATERAL 'FIELD LOCATION
DATE OF CONSTRUCTION: 0
BUILDING ADDRESS 22liz.,I a:(o
STREET A ycu.,..e_ S�K ,�.c). s-W-
SUBDIVISION: L A
NORTH ARROW
L
c- Co 6�kkCLL 03 AcxaX
CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUP RVISOR (PRINT)
53 .5
STREET ADDRESS SIGNATURE
TOWN STATE ZIP INSPECTED BY TOWN
DATE
TELEPHONE NUMBER
WHITE — TOWN PINK — CONTRACTOR YELLOW — CONSULTING ENGINEER / DEVELOPER