HomeMy WebLinkAboutdrain layer permit 352 Sullivan Avenue 1000011 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER
DRAIN LAYER PERMIT
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DATE: 04/12/10 aa\`\oaaa'm\\\\ „""s �\ \\4 ' \\ \\\\\\\
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GIS ID: 87300352 " v uvvawvau"�� \v
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MUNIS APPLICATION# 201000375 w�,vJ, , O�,a��i0`� a� v� �� ��v ";�"�� 60.00
�I\fly avv��� °�' �vvvvv\vyvuuuu�nu�a� � ���� �w \� �� \EXPIRATION DATE: 05/12/10
APPLICAN
NAME: JAMES THROWE DB 1, aywer,1° 1,"�� a w� °��v\ �\ �a'w v` ��\, A�\ LOCATION
a �i � ��` ""�3 SUL 'VAN AVENUE
ADDRESS: 97 RIVERSIDE DRIVE �� " �a�"� v Q� ��
K JOHN J JR TRUSTEE
VERNON ROC
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PHONE 860-289- a;�� \�av��`�V�� v ( �, R, 06074
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WORK DESCRIPTION: DISCONN � �
THE DRAIN LAYER ASSIGNED TO THIS P
a 1 H �STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORTH �'�„�
THE TOWN OF SOUTH WINDSOR STANDARD
"� l vo SHALL BE IN ACCORDANCE WITH
. �a \ \\ �` ;r,, ATTACHED CONDITIONS.
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ISSUED BY D TE SPECTED INSPECTED BY
4/12/2010 1:58 PM
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: ®jI CONTRACTOR: CffF"s _I ock)e
LOCATION S-5 Q I44,
TYPE OF WORK: ern 0 ppcli- -So V13 A
DATE INSP NEEDED: DATE INSP: �Z�'°
INSPECTED BY:
WORK IN
PROGRESS: C on e --e r -o a o� r� Fuc_
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SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: DATE:-7 /1
4
L
W/2004rown of South Wind§6r INPSEMON REPORT 07
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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: `i-J Lot #
Street No. Street Name
Premises owned by: 1A✓�,��co uk
',6V(,T3* Name of Firm: Phone:
Address of Firm: or
TYPE OF WORK: Cap ls�r—
Lay House Drain_,: Repair House Drain :
Lay Main : Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with )O j v r
Existing Water Supply: Public Water_ Well
Proposed Start Date Estimated time for completion L��
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 the holder of Drain
Layer's License No. _le.,Ccd�8 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.QQ10 l 5h /,2 s3
Signed: ` Print Name:—Ta/4e s-71r —
Licensed Drain Layer
Date: /C2 4P
Standard F0M1S\Permit WPUCATION FOR DRAIN LAYERS PERMIT.doc
TOWN OF SOUTH ANDSOR
SANITARY:- SEWER LATERAL. FIELD LOCATION
DATE OF CONSTRUCTION: //Q Zd ,
BUILDING ADDRESS j
STREET
SUBDIVISION:
NORTH ARROW
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CONTRACTOR (PRINT) NAME 0 CONTRACT SUPERVISOR (PRINT)
STREET ADDRESS SlGfT
JPRE
�r�✓��n CT 0(1066 DATE
TOWN STATE ZIP INSPECTED BY TOWN
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DATE
TELEPHONE NUMBER
WHITE -'TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER