HomeMy WebLinkAboutdrain layer permit 136 Mark Drive 1000029 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER
RAIN L AYER PERMIT
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DATE: 06/22/10
GIS ID: 57000136 �\ \\
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00MUNIS APPLICATION# 201000761 �1 g EXPIRATION DATE: 07/22/10g" jv
APPLICAN'av
NAME: SIMSCROFT ECHO F v` ��vvv`wVAvv�1v\�\,vva "„v \wv v LOCATION
ADDRESS: P O BOX 581 \, \`°' \\�� \ ���\" \,RE�. 1 M DRIVE
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SIMSBURY CT 0607,
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PHONE \ � I" SOR,CT 06074
WORK DESCRIPTION: RELAY S
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THE DRAIN LAYER ASSIGNED TO THIS P
THE TERMS AND CONDITIONS SET FORTH CH
S " " TFi � TATE AND HEREBY AGREES TO ALL
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THE TOWN OF SOUTH WINDSOR STANDARD \�\ \"(� maw M ATTACHED CONDITIONS.
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ISSUED BY DATE INSPECTED INSPECTED BY
6/22/2010 1:42 PM
TOWN OF SOUTH WINDSOR INSPECTION.REPORT
PERMIT NO.: CONTRACTOR: Sl m'5 C ra
LOCATION "` I /
TYPE OF WORK: CCU OASlie.
DATE INSP NEEDED: DATE INSP: Co 93bo
INSPECTED BY:
WORK IN
PROGRESS: Ca,-p_ ke r„f.5 PvG 5�2 3S Prow► 8 sue., /► /a
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SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED [) YES ❑ NO
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INPUT: Y V `-- DATE:
W12007 Town of South Windsor INPSECTION 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: 136 AA(Zj� t #
Street No. Street Name
Premises owned by:
Name of Firm: Yy,�s FdXV � Phone: FdQ
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Address of Firm: esw�r 4 sb
TYPE OF WORK:
Lay House Drain ; Repair House Drain ;
Lay Main ' ; Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with 91)Q 3
Existing Water Supply: Public Water Well
Proposed Start Date "2- Estimated time for completion - 3v Zo J v
ALL WORK TO BE IN ACCORDANCE WITH TOWN OF SOUTH WINDSOR STANDARDS,
ALL OSHA REQUIREMENTS AND CONDITIONS ATTACHED TO THE PERMIT
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Permit is to be issued to �1\N1CG�1F &2L6 rdYM" the holder of Drain
Layer's License No. 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. -26l O— 266
Signed: 6 , 2A4/&� Print Name:
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Licensed Drain Layer
Date:
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc
TOWN OF SOUTH WIN MR
SANITARY SEW LATEM),L FIELD LOCATION
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CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPERVISOR,(PRINT)
STREET ADDRESS SIGNATURE j
�' � a-� �•'!.� DATE
TOWN STATE ZIP INSPECTED BY TOWN
DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER