HomeMy WebLinkAboutdrain layer permit 370 Nevers Road 1000036 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 07/30/10
GIS ID: 62400370 FEE: 00
MUNIS APPLICATION# 201000963 � � - EXPIRATION DATE: 08/29/i0
APPLICAN LOCATION
NAME: SIMSCROFT ECHO F �
RE NE RS ROAD
ADDRESS: P O BOX 581 =
JOSEPH JR
SIMSBURY,CT 0607 _ ( £ .V RS RD
PHONE 860-651- 2 _ = �V�INDSOR,CT 06074
WORK DESCRIPTION: REPAIR
PART OF VE R
THE DRAIN LAYER ASSIGNED TO THIS :SSiI TATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FOR �, •T • RK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STAND tom. A' ATTACHED CONDITIONS.
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ISSUED BY DATE INSPECTED INSPECTED BY
7/30/2010 9:32 AM
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
. PERMITNO.: 100(90 S& CONTRACTOR: �71 -
LOCAT[ON:- 0
TYPE OF WORK. c -
DATE INSP NEEDED: DATE INSP:
INSPECTED BY: g
WORK IN
PROGRESS: 42ow - r ksca"..,e�,�! LG��x-2 o,co
SEPTIC TANK PUMPED, SMASHED, FILLED
WITNESSED E] YES ❑ NO
AS-BUILT: 1/
INPUT: DATE:
W12007 Town of South Windsor I psEMON REPORT 07
AeP6C►sha Zo l 000�63 O
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:_ Lot#
Street No. Street Name
Premises owned by:
Name of Finn:_ rn s rrs Phone: gFG o
Address of Firm: ��
TYPE OF WORK:
Lay House Drain • RP pir House Drain
Lay Main Latera or Commercial/Industrial
Building •of acres
Connection will be made with G
EAsting Water Supply: Public Water A---' Well
Proposed Start 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 _?�29 �s.�►••�.s�i the holder of Drain
Layer's License No. � o�7 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 terns
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.
Signed: Print Name: «/ s�� s
Licep4d Drain Layer
Date:
Standard Forms\PWWts\APPUCATION FOR DRAIN LAYERS PERMIT.doc
TOWN OF SOUTH WINDSOR
SANITARY '. SEWER LATERAL FIELD LOCATION
DATE. OF CONSTRUCTION:
BUILDING' ADDRESS : 7a
STREET :: S
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CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPERVISOR" (PRINT)
STREET ADDRESS' �— SIG TURE
S C � _ �, �.c� DATE
TOWN STATE ZIP INSPECTED BY TOWN
DATE
TELEPHONE NUMBER
WHITE — TOWN PINK — CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER