HomeMy WebLinkAboutdrain layer permit 1127 Sullivan Avenue (2) e • TOWN OF SOUTH WINDSOR INSPECTION REPORT
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Permit No. A mess , '
3127 SULLIVAN AVENUE � W. g`'p�D � C� 061
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Permit No. 7738 Town of South Windsor, CT
Permit Date 04/23/2004raa�, x Drain Layer Permit
Expiration Date 05/23/2004
Descrip; REISSUE PERMIT
Applicant y�°Y `*! i , ` La a�twion
Name CINAMI EXCAVATIONf Leb < l .
i 2 9�U V NUE
LIsx �7E,
Addr. P.O.BOX 340 ° ' £ z
n' y: QS;i"J1$N CLAUDIA A
OLD LYME KC� 6h7 'mrs �u d
d
Phone No. (860)884-18p1
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The Drain Layers, �t ` h
.` . d d l�c ;fsI iL u d by the
state and hereby ag�,ee tq the s ` �k fo h in the
attached 'ConditionsIt 1« w�h W. of South
Windsor standards, aA OSHA,re u
e. E c `con� itions.
Issued By —A�— 1�^i , •i• ��= rem y
Date Ins ected "w '` �"
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-7-73X
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 Z-7 s„ ,_,.�,��, ,4,,,� Lot #—/
Street No. Street Name
Premises owned by:_ ,S,�AJ
Name of Firm: Phone:_ ,S
Address.of Frm: P, d �yu � �.� 7•,,,�=, 7/
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 Estimated time for completion
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 _s; T , the holder of Drain
Layer's License No. 2-7 sG g 3 v.:z , 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.
Signed: — Prin
t Name:_
Licensed. ain Layer
Date:
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc
TOWN - OF SOUTH ANDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: 1,4
BUILDING ADDRESS : //..,�7 Su a� i4veli LAe
STREET
SUBDIVISION:
Swl(iva,.- Ave-,
NORTH ARROW
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CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPERVISOR (PRINT)
STREET ADDRESS SIGNATURE //
D z�� L7 P' CT 06�`?,�_ �(./✓ DATE
TOWN STATE ZIP INSPECTED BY TOWN
97- DATE
TELEPHONE NUMBER
WHITE TOWN PINK — CONTRACTOR YELLOW — CONSULTING ENGINEER / DEVELOPER