HomeMy WebLinkAboutdrain layer permit 333 Deming Street 1000012 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 04/20/10 ��u"m`"mA���� ��N
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GIS ID:27600333 6`0�' a°� � "��
e 1a%\4 `\ r FEE: 60.00
MUMS APPLICATION# 201000346 �"" � "� "q u w EXPIRATION DATE: 05/20/10
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APPLICANT„ �1° ��,,, o�
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NAME: J&H SLATER CONST ,m ` �o � �
ADDRESS: 75 COMMERCE WAY \
DE ING STREET
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SOUTH WINDSOR,C 6%4 °�°�°'""
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SOR,CT 06074
PHONE 860-528-5 S ua Q '`�� �� no"dem
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WORK DESCRIPTION: NEW SE
NEW LA RAL R �
THE DRAIN LAYER ASSIGNED TO THIS �\ AS D BYE S TE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FOR ' ATTACHE TIO SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STAND L SHA RE ENTS,A ACHED CONDITIONS.
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ISSUED BY D INSPECTED BY
4/20/2010 12:18 PM
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: f DOa0 CONTRACTOR: ` y S)e-lee
LOCATION: 33 h-,,i
TYPE OF WORK: S� Pf c.
DATE INSP NEEDED: DATE INSP:
INSPECTED BY:
WORK IN
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INPUT: . DATE:
W12007 Town of South Windsor INPSECTION REPORT 07
Permit -Vlaaao /.
APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
aPP/ 010/000 3 Y6 TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $60.00
Location of proposed work:_ � n�11JCr Lot #
Street No. Street Name
Premises owned by: Jf\q Sq YN 5��
Name of Firm: Phone: 28 �-SZ-SZ
Address of Firm: I's C' (/11M wm
TYPE OF WORK:
Lay House Drain--)� r Repair House Drain
Lay Main : Lay Lateral for Commerdai/Industrial
Building of acres
Connection will be made with
Existing Water Supply: Public Water, Well
Proposed Start Date 'y l l 0 Estimated time for completion .2 weticS
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 C6.�C-a l E-[L the holder of Drain
Layer's License No.�? 9 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. AO(C)C j 0-33 49
Signed: Print Name:_
'censed Drain Layer
Dater (�
Standard Forms\Permit WPUCATION FOR DRAIN LAYERS PERMIT.doc
TOWN OF SOUTH - WINDSOR
SANITARY SEWER LATERAL- FIELD } LOCATION
DATE OF CONSTRUCTION: ti
BUILDING ADDRESS
STREET
SUBDIVISION:
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CONTRACTOR (PRINT) NAME CONTRACTOR'S SUPERVISOR (PRINT)
WYH 46
STREET ADDRESS SIG RE
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TOWN STATE ZIP INSPECTED BY TOWN
DATE
TELEPHONE NUMRER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER