HomeMy WebLinkAboutdrain layer permit 177 Clinton Drive 1000027 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER _ DRAIN LAYER PERMIT
DATE: 06/11/10 g
GIS ID:21300177 ' 2
0 x FEE: 60.00
MUNIS APPLICATION# 201000707 yWEEXPIRATION DATE: 07/11/10
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APPLICAN � }=s LOCATION
NAME: SKIPS SEPTIC
RED" 17 CLITON DRIVE
ADDRESS: 6 NUTMEG DRIVE , LEIGH F
P O BOX 29 s
IITON DRIVE
ELLINGTON,CT 06011 INDSOR CT 06074
PHONE 860-87533 -
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WORK DESCRIPTION: NEW SE -.j VC OAl v
THE DRAIN LAYER ASSIGNED TO THIS JP k.A `- S Y STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FOR A C I... — RK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDARD ,S Aft- ATTACHED CONDITIONS.
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO,: )OocZ 7 CONTRACTOR: iys ��-► �G
LOCATION: 4`17 GU/JTo;�Z) Dwv>✓
TYPE OF WORK: (e�xU ' tA"Aitt7rk"S
DATE INSP NEEDED: 4,-a-s-lp DATE INSP:
INSPECTED BY: -S,S4g
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W12007 Town of South Windsor INPSEMON REPORT 07
APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, Cr
FEE $60.00
Location of proposed work: 177 C l-r dc%A 'J�)X Lot#
Street No. Street Name
Premises owned by: ,- -e la 67q e v r y
Name of Firm: Phone: 86 o ?S" 2 3 3 2—
Address of Firm: N a-1jk EG 0 &ay, 29- /-Z- -,v 6
TYPE OF WORK:
Lay House Drain e, Repair House Drain
Lay Main Lay Lateral for Commerdal/Industrial
Building of acres
Connection will be made with � l'Vc- S?s7L 3
Existing Water Supply: Public Water K Well
Proposed Start Date 6-(0-i0 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 `'4 A 9,� the holder of Drain
Layer's License No. zQ 7,7 z s . Only holders of P-1.L-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.
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Sign : Print Name: y 7�fdA q�s Gu q4k
Li ensed Drain Layer
Date: (0
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Standard F0nW\Pffn tsWWCAIION FOR DRAIN LAYERS PERMMdoc 19
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: S
BUILDING ADDRESS
STREET
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CONTRACTOR (PRINT) NAME 0 CONTRACTOR'S.SUPERVISOR (PRINT)
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SfRREET ADDRESS SIGNATU
DATE
TOWN STATE ZIP INSPECTE-b BY TOWN
DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER