HomeMy WebLinkAboutdrain layer permit 1000 Sullivan Avenue TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 7908
Location 1 Cont is �' ONSTRUCTION CO(DARRYL)
" LL T AVENUE
Type Work NEW SAN LA yr� 535 L S FORD ROAD
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Permit No. 7908
Permit Date 04/26/2005 Town of South Windsor, CT
Expiration Date 05/26/2005 r. Drain Layer Permit
Descrip: CK 5094 $4774.77, C
' O 0 19.6 SULLIVAN
Applicant
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Name WILCOX CONSTRUCTfo s`� Y' ;
Addr. 535 OLD STAFF OR R '� sf 'rA�NUE
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Phone No. a' "r
(860)871- 9�x :r �: 'xgggg
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The Drain Layer,
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state and hereby a re °ss;dued by the
t t et o th in the
attached 'Condition 1 .,„,
Windsor standards, a 1 OS.H 3r. x .•` " Al�lwtvn of South
s d c ditIons.
Issued BY/ ''
Date Inspected „ ;,�"
TOWN - OF SOUTH ANDSOR
SANITARY SEWER LATERAL FIELD -LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS : ooe �-\Oa A\ AV 4., LA,
STREET : —e- st .*kN vi
SUBDIVISION:
NORTH ARROW
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CONTRACTOR (PRINT) NAME 0 CONTRACTOR'S SUPERVISOR (PRINT)
STREET ADDRESS SIGNATURE
DATE
TOWN STATE ZIP INSPECTED BY TOWN
9"7- —/� 1? 3 DATE
TELEPHONE.NUMB,ER
WHITE - TOWN PINK - CONTRACTOR 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:_ g a'\W to S„�t , .,A I/ Lot #
Street No. Street Name
Premises owned by: :�c.J- L e.o v*.V'
Name of Firm:_ (�;�_�x G�„�s - Phone:
Address.of Firm:_ 53 S o4ok S j,-QC..A RA
TYPE OF WORK:
Lay House Drain ; Repair House Drain ;
Lay Main ; Lay Lateral-for Commercial/Industrial
Building of acres
Connection will be made with PVC- SA- 35
Existing Water Supply: Public Water Well
Proposed Start Date S- .7--105 Estimated time for completion ( — 7-o S-
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 IwAder of Drain
Layer's License No. d Only holders of P-1, 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. 2—go S k Cv O a t 0
Signed: rint Name:_
Licensed Drain Layer
Date: Z/- o S
Standard Forms\Permits\APPLICA'tION FOR DRAIN LAYERS PERMIT.doc
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