HomeMy WebLinkAboutdrain layer permit 18 Birch Hill Drive 1000015 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 05/04/10
GIS ID: 11400018 %
MUNIS APPLICATION# 201000502 ctw FEE: 60.00
- EXPIRATION DATE: 06/03/10
APPLICAN lk LOCATION
NAME: SKIPS SEPTIC _ '` y
ADDRESS: 6 NUTMEG DRIVE � $ IRC HIT DRIVE
P O BOX 29 -Al � g� ICE&DAVID P
13IRE HILL DRIVE
ELLINGTON,CT 060 �
s la SOR,CT 06074
PHONE 860-875 g= 5 -K =
WORK DESCRIPTION: NEW SE
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THE DRAIN LAYER ASSIGNED TO THIS P H I _ �� TATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORTH CH - TF L' RK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDARD LI3 STD T_ ATTACHED CONDITIONS.
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5/4/2010 9:37 AM ISSUED BY DATE S ECTED INSPECTED BY
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: 10600/s CONTRACTOR: c5 ias
LOCATION:
TYPE OF WORK:
DATE INSP NEEDED: - DATE INSP: /0 o
INSPECTED BY:
WORK IN
PROGRESS: ('o4a4-0 r ,n Co", e V C flR-3 5
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SEPTIC TANK PUMPED, SMAS 'D, FILLED--V WITNESSED ❑ YES ❑i-Pd'O
AS-BUILT:
INPUT: C DATE:��
W/2007 Town of South Windsor INPSEC HON REPORT 07
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: IS Smci! A11A_Z bn Lot #
Street No. Street Name
Premises owned by: PV(P t AILI1C AlAk-S`
Name of Firm: s (PS Sic P r7 c_ Phone: Fo 0 ?'7 r 2 33 2
Address of Firm: 0 , &0'< A/
TYPE OF WORK:
Lay House Drainer Repair House Drain
Lay Main '
Lay Lateral for Commercial/Industrial
Building of acres
Connection will be,made with Pyc- 5-�> 3 5-
Existing Water Supply: Public Water Well
Proposed Start Date wk o" s 2r f 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 the holder of Drain
Layer's License No. 7—a ??z f Only holders of P-1, P:Z 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. -,9-°lO 7 S 3/ a
Signed: Print Name: _?M ' i9f
Licensed Drain Layer
Date: 3 r /0
Standard forms\PWT ts\APPUCATION FOR DRAIN LAYERS PERMIT.doc
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