HomeMy WebLinkAboutdrain layer permit 1148 Sullivan Avenue s - V
TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 7426.Y Contractor MID STATE SITE DEV.
Locationjpgy "" Address P.O. BOX 654
Type Work NEW SAN LAT
CANTON CT 06019
o ,mot a No. (860 )693-6899
Date Insp Needed
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Time Insp Needed V/ll
Inspected By - -
Work in Progress
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Date
-P.dri ftiAt oN .. 7426 'Town of South Windsor, CT
Pe,rmie-Date 05/14/2002 .r Drain Layer Permit
Expiration Date 06/13/2002
Descrip: INSTALL SEW. LAT. TO EXIST. HOUSE
Applicant Location
Name MID STATE SITE DEV. 1 SULLIVAN AVENUE
Addr. P.O. BOX 654 EL DY-AMBACH NILA R &
CANTON CT
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Phone No. ( 860)693-6899
The Drain Layer a s s as �i cense issued by the
state and hereby agr e h " nd i s set forth in the
attached 'Conditions'''.W1 a c with Town of South
Windsor standards, al' q ' ached conditions.
Issued By �t �(LNAx � �✓ �N(,
y
Date Inspected � 0. see
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: 1IL71167 s������ /Waot #
Street No. Street Name
Premises owned by: MLA &EJ1CCg(-LM)5AC
�n
Name of Firm: /�/f�� � Phone:
Address of Firm:- 1
TYPE OF WORK:
Lay House Drain �� ; Repair House Drain ;
Lay Main ; Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with Sty(= ;
Proposed Start Date /� Estimated time for completion ?jjA
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:
Licensed Drain Layer
Date:
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc
y TOWN OF SOUTH WINDSOR
SANITARY . SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: "
BUILDING ADDRESS `-
STREET : J�u��/l/ �4 L/ s
SUBDIVISION: ��Qj g e P e
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CONTRACTOR (PRINT) NAME OF CONT TOR'S SUPERVISOR (PRINT)
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STREET ADDRESS SIGNATURE
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A61c7 DATE
TOWN STATE ZIP J INSPECTED BY TOWN
DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER