HomeMy WebLinkAboutdrain layer permit 24 Lavender Lane 1000006 TOWN OF SOUTH WINDSOR, CT
PENT NUMBER DRAIN LAYER PERMIT
DATE: 03/17/10
GIS ID: 52600037
FEE: 60.00
MUNIS APPLICATION# 201000226 EXPIRATION DATE: 04/16/10
APPLICANT LOCATION
NAME: JACQUES CONSTRUCTION( HN� VTDER LANE
ADDRESS: 67 RIDGE ROAD COITRUCTION CO INC
SOUTH WINDSOR,Cl(�7 Im-I GTON ROAD
g y T-H-, DSOR,CT 06074
PHONE 860-432-103
W
WORK DESCRIPTION: NEW SEE ,
THE DRAIN LAYER ASSIGNED TO THIS Pq$Rl AAASE� FATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORT IIHL v,; N SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDAIfl�S, SIA TiTTACHED CONDITIONS.
/ 4-J R gr
ry /
ISSUED BY DATE SPECTED INSPEC D BY
3/17/2010 10:57 AM
DATE INSP NEEDED: DATE INSP:
INSPECTED BY:
WORK IN PROGRESS:—Crn�mr-1 r i k A C.-pVc- St)235 r-r-co"' f
J o 'dLOMJA. as AeoA
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: ��' DATE: 00/ 0
W/2007 Town of South Windsor INPSECFION REPORT 07
APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
a 4/4�a oZ PUBLIC WORKS DEPARTMENT
p� TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT-
FEE $60.00
0?7
Location of proposed work: #
. y� �,e L -�
�� �/ (/l. Lofi a'
Street No. Street Name
Premises owned by: T G oiS&"
Name of Firm: c-0/0- Phone: aB�06'S
Address of Firm:_ �a'S$ �, �5 Ivy P 56v
TYPE OF WORK:
Lay House Drain_ : Repair House Drain
Lay Main ; Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with
Existing Water Supply: Public Water ✓ Well
Proposed Start Date 17 /D Estimated time for completion l D
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 -j-g(6'z41c0L)e5 209'1�0 the holder of Drain
Layer's license No. ROYg30 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.
LSigned: Print Name: U�� 3vC ay
Lice ra' yer
Date: l7 10
Standard Fbrms\PermitsWMCATION FOR DRAIN LAYERS PERMrr.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERALTIELD LOCATION
DATE OF CONSTRUCTION: A a rGP) 2 a', 010 �' �•
BUILDING ADDRESS : Lot a�
STREET L a eh der- Lan 'e
SUBDIVISION: b err if
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NORTH ARROW
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CONTRACTOR (PRINT) NAM OF CONTRAC OR'S UPERVISOR (PRINT)
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STREET ADDRESS SIGNATURE
Js'o r c-! 04 0 rJ ��DATE
TOWN / STATE ZIP INSPECTED BY TOWN
of oz DATE
TELEPHONE NUMBER.
WHITE - TOWN PINK CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER