HomeMy WebLinkAboutdrain layer permit 1164 Sullivan Avenue (2) TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 7853 Contr, RY TTtR2a+>�CAVATION LLC
Location ire 121 1L VI*hLE SCHOOL RD
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Type Work NEW SAN LAT " ."y
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Permit No. 7853 Town of South Windsor, CT
Permit Date 11/03/2004 , w� Drain Layer Permit
Expiration Date 12/03/2004 m•y
Descrip: L ` Y •••., „;.
AY HOUSE DRAIN „,�`' � '�,',r'�i' � �^"�• �F' 2y�y 'a,.
:E�'• SH'c "''`fti' .:.;:u}c::cui Foian>.yN $ :f5' ��"rs,..
Applicant vs> a: fh. 4•' '"a` Xy Lta on
Name TERRA EXCAVATION L a pSuT, V k' VNUE
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Addr. 121 DALEVILLE S - 00 1 r RTIN A3T /U
WILLINGTON s C � 27973
Phone No. (860)429-49:80 '• "
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The Drain Layer
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r spued by the
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state and hereby agr�eeg
t � th � 5� '��Er et fork in the
attached 'Conditions?.'•, 113a"v. n ��th4vn of South
Windsor standards, a17 OSHA° �usta ` tie aoss�ditions.
Issued By
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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 $60.00
Location of proposed work: S'Avvb,,N A -e Lot #
Street No. Street Name
l'rArrk
Premises owned by: e coo 12 Am-rO
Name of Firm: —e-c-c� fir. nv� Phone:_�i-Go -4a9-4Sriro
Address of Firm: 1ai to Lie �l
TYPE OF WORK: _
Lay House Drain / ; Repair House Drain ;
Lay Main ; Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with 6' "Pve. so2ss—
Existing Water Supply: Public Water Well
Proposed Start Date ti is o` Estimated time for completion /i jerk
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 Pe.k-er -1-k, th older of Drain
Layer's License No. egos/s Only holders of P- P-7 or W-9 licenses
will be issued a permit. PERMIT WILL EXPIRE THIRTY (3 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. :Z 3 Z o t
Signed: 14"f Print Name:
Licensed Drain Layer
Date:_ /� o
'Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc
Date:
PAT-1 Rev.5/91
l/ 3� State of Connecticut I)W' tt r�i fornt must be
Department of Transportation filled in completely and
Fee:(for DOT use) APPLICATION FOR PERMIT mailed or delivered to the
Printed on Recycled or Recovered Paper
Bureau of Highways District Office.
LOCATION OF PROPOSED WORK:
(a) Town:_S.W-nAso2 (b) Router_ (c) Street Name&No.
(d) (Circle One)(D S. E. W. side of Highway. (e) Located Between Utility Poles No. /O/ &No. /o
(f) Distance and direction from nearest intersecting road. dau �. -"'"miles(N. S. E.(9�of Calltvls (St/Rd;
Application is hereby made to:(Describe fully&include sketch or attach plans) 4 a =A-"
LAIAP- lit*
Department of Transportation
District #1 Office
1107 :!r-onz we3-1 Avenue
Rocky Hill, Connecticut 06067
PERMIT FEE can be paid only by check or money order payable to Treasurer-State of Conn.
Name of Surety Company&amount of Bond Permit to be issued to:
O Name , t�� i
Party to whom Bond is Issued: G ..tit 27_szt, L._
Print Name Q M t_C.. &
signed Phone ,o Address_AQZ D!%J&V;J1e c f �
'arty to whom Insurance is issued: Town CT— ZIP
Tint Name leiLM The owner of the property for whom this work is being performed
agrees to accept all future maintenance responsibility for the work
tigned � PhondSY -4 Q S'p specified in the permit. LC.G
approximate Time Required Desired Starting Date Print Owner's Name t tt0 a�kS t�y1
i
O/1 OAY !/ �1p4 Address It vA..
:omplete Plans and Specifications must be submitted for major
ncroachment permits.On other work a careful sketch shall be shown Signed Phone .060 24 f,
t space.above or on back side of application.
TOWN OF SOUTH ANDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE. OF CONSTRUCTION:
BUILDING ADDRESS
STREET : S� l �vg� ✓�:
SUBDIVISION:
NORTH ARROW
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CONTRACTOR (PRINT) NAME OF C CTO 'S SUPERVISOR (PRINT)
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STREET ADDRESS SIGNAiVRE
!Ji✓` << n DATE
TOWN �— STATE ZIP INSPECTED BY TOWN
(Lo) y4- y �'FO DATE
TELEPH�ONE�N-UMBTR
WHITE - TOWN PINK - CONTRACTOR YELLOW -' CONSULTING ENGINEER / DEVELOPER