HomeMy WebLinkAboutdrain layer permit 1105 Main Street 1000039 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 08/06/10 4 of
GIS ID: 54901105 FEE: 60.00
MUNIS APPLICATION# 201000999 - EXPIRATION DATE: 09/05/10
APPLICAN OCATION
NAME: BARBER UTILITIES I S : 5'MA` STREET
ADDRESS: 35 PINNACLE ROAD IM JAN M&
ELLINGTON,CT 060 9 - I ST
SOR,CT 70 35 2
PHONE
1
WORK DESCRIPTION: NEW SE
THE DRAIN LAYER ASSIGNED TO THIS P STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORTH H T L ORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDARD - s E ATTACHED CONDITIONS.
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ISSUED BY DATE INSPECTED INSPECTED BY
8/6/2010 2:28 PM
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
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PERMIT NO.: 3 Q
CONTRACTOR:
LOCATION II malt) 3 jr(f
TYPE OF WORK: ��� Yti
DATE INSP NEEDED:_ DATE INSP: 3 ba
INSPECTED BY: G D
WORK IN
PROGRESS: (�` o r -1',.►cLJI� (a
r Cennej- �t°' PyL Scf, LFo
SEPTIC TANK PUMPED, SMASHED, FILLED
WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT:�� DATE:
W/2007 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, CT
FEE $60.00
Location of proposed work:_- //or AM-tou37-Xc� Lot #
Street No. Street Name
Premises owned by:
Name of Firm:_ V77(_1� S Phone:,6ao- 5D9-6r33
Address of Firm: 3S- 90, Ar1z-ltic 7br.) C 3r, 00 Zy
TYPE-OF WORK:
Lay House Drain-- Repair House Drain
Lay Main : Lay Lateral for Commerdai/Industrial
Building of acres
Connection will be made with _AU68t:W- bw a-.6 Pt®�
Existing Water Supply: Public Water Well
Proposed Start Date Estimated time for completion kYS
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 tX 0• 0 S I L?W-s the holder of Drain
Layer's License No.-7- 02763541 . 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. _2016 3 2 o IA 22
Signed: c Print Name: y/P ;5/�Pf
Licen Drain Layer
Date:
Standard Forms\PM t WPLICATION FOR DRAIN LAYERS PERWT.doc
TOWN OF SOUTH WINDSOR
SANITA.RY : SEWER LATERAL 'FIELD LOCATION
DATE OF >CONSTRUCTION 5bV/p
BUILDING ADDRESS
STREET
SUBDIVISION:
NORTH ARROW
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CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPERVISOR. (PRINT)
STREET AD RESS SIGNATURE
�J c O(o DATE
TOWN / STATE ZIP INSPECTED BY TOWN
(. z? 0 DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER f DEVELOPER
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