HomeMy WebLinkAboutdrain layer permit 651 Sullivan Avenue TOWN OF SOUTH WINDSOR INSPECTION REPORT
-s
Permit No. Contractor COVEN"CON:STRUCTION CO.
4
Location
P BO
YPeWork ...RPR 6
T Address O Y. 2 T
AN LAT
� .ENT'RY C-T 06*
Phone"
Date Insp Needed
------- Date
Time Insp Needed
Inspected By
T3
Work in Progress
- `
994� �u
rr n ow
r
Permit No. 7744 Town of South Windsor, CT
Permit Date 05/19/2004
Drain Layer Permit
Expiration Date 06/18/2004
Descrip: OIL/WATER SEPARATOR . "
Applicant
X. li
v0 tion
K.
Name COVEN CONSTRUCTION CQ �ic�C�� r C�6�� S�LLXV�N. AVENUE
Addr. P.O. BOX 427 Ctiaiaer H & G'
REALTY t LC
COVENTRY
F
Phone No. (860)282-0526
The Drain Layer assigned t,ltis r� $ s 3ty f id 7 5 ed21Se stied by the
state and hereby agi�eee: tv aI'1 �he 'te ms shd candi ao t rye yet for in the
attached 'Conditions, . A11 wor s7ta`333' vane;w3tli Town of South
Windsor standards, all OSHA x.equir'emis alxd tie atachedo.nditions.
Issued By —
Date Inspected -------------- >+Y hrpe.e'C
• 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:_ �-� I (,(,(u�w 1 )CLot #
Street No. Street Name
Premises owned by: ' _ Q �- L
Name of Firm: COO L,n-) ti Phone: Z 0_2 q�
n
Address.of Frm.-R 13ok
TYPE OF WORK:
Lay House Drain Repair H use Drain
Lay Main - ; Lay Laterar fo ommercial Industrial
Building of acres
Connection will be made with
ExistingWater Supply:
Public Water Well
Proposed Start Date b Estimated time for completion
ALL WORK TO BE IN ACCORDANCE WITH-TOWN OF SOUTH WINDSOR STANDARDS,
ALL OSHA REQUIREMENTS AND CONDITIONS TTACHED TO THE PERMIT
Permit-is to be issued to L^)y �`�- CG"-y th older of Drain
Layer's License No. _ ray qq (, - _. Only holders of P-1, - or W79 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.
WSigned: Print Name: �c �✓ d c,,,f
Lic nsed ra yer
Date:S 0 Y
Standard For s\Permits LICA IION FOR DRAIN LAYERS PERMIT.doc
:f",
l TOWN OF SOUTH WINDSOR
Sk�;.-ITARY .',. SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: �5 a. j . Oq
BUILDING ADDRESS':,' j
STREET QYJAJ /Q U
SUBDIVISION:
NORTH ARROW
t
r
..._.----
--'`
�__.___�.____..�._. ..f.._-_.}__..__.3__._.;.-....._.-1-..__.;__—_I-_.._.___._i...__..__i. ..- i- ,_ _fi.__ 3 .-- �__-_- - -.:._�_._. �.-__ '_:__.a�._t____;_._._._�.._.---tr--_-.->"-__.._j----•t------.}.--_ j._._.._E
1w
pi 65
1 t
�y �r� �pr)S� ft C
CPU
C NTRACTOR (PRINT) NAME OF :7CTQR Sl SUP NT);
fo
STREET ADDRESS SIGNATURE
►V�✓� Cj 06) C=!mm;�� DATE
TOWN STATE ZIP INSPECTED BY TOWN
DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER
TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL gip No.:
South Windsor, Connecticut
List No.: _
DRAIN LAYER'S PERMIT 3358
Pursuant to written applicatior, per fission is hereby gmnted to the Licensed Drain Layer named herein to perform
the work indicated below at �'�� f�CL t� l ��V`� on the
side, between
at premises owned by
whose address is
and to Lay House Drain, Repair House Drain, Lay Main, Other
for occupancy or use,
with Family Units, with acres.
Type of Sewage to be connected under this permit:
SANITARY SEWAGE ( ), INDUSTRIAL WASTES ( ), OR
Connection will be made with
Permit to be issued to
the holder of Drain Layer's License No. Permit will expire on 19
The undersigned Drain Layer hereby agrees to all the terms and conditions set forth on the permit and the reverse side
thereof. Applicant has received Town Permit No. and/or C H D Permit No.
for street excavation.
SPECIAL CONDITIONS
Signed
Connection Charge Pai���DO-� C) CL Licensed Drain Layer
Issued by
Tax Collector
Permit Fee: Paid $ _ �...
INSPECTION: Check Number: ��f�-
INITIAL (Sig) (10J-a4a,4id4Y
FINAL (Sig)
APPROVED (Date)
(Sig)
INSPECTOR