HomeMy WebLinkAboutdrain layer permit 390 Nevers Road 1000042 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
4
DATE: 08/11/10 _
GIS ID: 62400390
MUNIS APPLICATION# 201001038 EXPIRATION DATE: 09/10/10
APPLICAN LOCATION
NAME: SIMSCROFT ECHO F ARE NE RS ROAD
ADDRESS: P O BOX 581
§. DENNIS M LIU&
SIMSBURY,CT 0607 r V RS ROAD
= - J`W INDSOR,CT 113 53
PHONE 860-651 3 406
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WORK DESCRIPTION: REPAIR Y R
PART OF VER R131NC
THE DRAIN LAYER ASSIGNED TO THIS
f§A 981T TATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORT C T AL a RK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STAND ATTACHED CONDITIONS.
ISSUED BY DATE SPECTED INSPECTED BY
8/11/2010 2:57 PM
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: t-)- CONTRACTOR: sl V"S"C ro
LOCATION: O too
TYPE OF WORK:_ /lCf GjC, z e�_q �Sa/)
-DATE INSP NEEDED:______ DATE INSP: fid a
INSPECTED BY:_ _
WORK IN
PROGRESS: Co.,,, . Jc- �rt�
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SEPTIC TANK PUMPED, SMASHED, FILLED
WITNESSED ❑ YES ❑NO
AS-BUILT:
INPUT: DATE:
W12007 Town of Sout}i wndsor INPSECn0N REPORT 07
A�(x, 2Zol tang P tioY �oeo4
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: 3 �'d Lot
Street No. Street Name
Premises owned by:
#,!5 6264- Name of Firm: S .,,{ s c.,9--001 Ala, Phone: FGo -GS/-
Address of.Firm:
TYPE OF WORK:
Lay House Drain. Repair House Drain
Lay Main : Lay Lateral for Commerdal/Industrial
Building of acres
Connection will be made with S D e -
Existing Water Supply: Public Water Well A-f
Proposed Start Date _? j is Estimated time for completion 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 the holder of Drain
Layer's License No. o 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.
4
Signed:., `
9 Print Name:_ X/®,I
UcensedDrain Layer
Date: . .5i7-V ,0-0
Standard Forms\PermftsWPLICATION FOR DRAIN LAYERS PERMIT.doc
TOWN OF SOUTH WINDSOR
SANITARY - SEWER- LATERAL FIELD, LOCATION
DATE. OF CONSTRUCTION:
BUILDING' ADDRESS
STREETs-
+ SUBDIVISION:
NORTH ARROW
Ali
a
CONTRACTOR (PRINT) NAME ONTRACTOR S SUPERVI OR (PRINT
STREET ADDRESS SIGNATUR
TOWN STATE ZIP INSPECTED BY TOWN
61 DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER