HomeMy WebLinkAboutdrain layer permit 1156 Sullivan Avenue TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 7427 Contractor MID STATE SITE DEV.
Location -
Address P.O. BOX 654
Type Work NEW SAN LAT CANTON CT 06019
No. (860 )693-6899
Date Insp Needed Jc l lhs �QZ
Time Insp Needed W�t1 5 N
Inspected By
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""M-it Date 05/14/ 7427
ExpiratiQn Date 2002 Town of
Desc�ip .INS TALL06Z1312002 South Windsor,
SEW. LAT. Drain Layer Permit CT
TO EXIST HOUSE
Applicant
Name MI STATE
Addr.. Location p
PI SITE DEV.
BOX 654
r Jam ., 1 SULLIVAN AVENUE
CANTON sW '., A ELLI MICHAEL D
Phone No. (860)693-689CT°� �
The Drain Layer a s
State and hereby a r s
attached 'Conditions ' , as "Cense
Windsor 1 e � nd issued b standards, al Y the '
a 7O s set forth in the
G with Town of
Issued B
ached conditOf South
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Date Inspected ".
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APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Location of proposed work: f 61 S5141 UN) tgye- Lot #
Street No. Street Name
Premises owned by: 11! l&l AFL 9- J�AGOL)GII
Name of Firm:
� `��_� � � Peu Phone:
Address of Firm:_ �4 6N C 14- 6 h &
TYPE OF WORK:
Lay House Drain- SS Repair House Drain ;
Lay Main ; Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with 5 0L
141,
Proposed Start Date Estimated time for completion ID _
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 holder of Drain
Layer's License No. Only holders of P1, P7 & W9 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.
Signed: Print Name: Ole XOR 1'1', R-
Licensed Drain Layer
Date:
Standard Forms\Permits\APPLICAMN FOR DRAIN LAYERS PERMIT.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL . FIELD LOCATION
DATE OF CONSTRUCTION: 20 O -
BUILDING ADDRESS
STREET
SUBDIVISION: P_
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CONTRACTOR (PRINT) ) NAME OF CONTRA TORS SUPERVISO
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STREET ADDRESS SIGNATURE
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TOWN / STATE ZIP INSPECTED BY TOWN
DATE
TELEPHONE -NUMBER
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