HomeMy WebLinkAboutdrain layer permit 398 Nevers Road 1000037 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER
DRAIN LAYER PERMIT
DATE: 07/30/10 XF
GIS ID: 62400398
MUMS APPLICATION# 201000964 � FEE: 00
y EXPIRATION DATE: 08/29/10
t _ _
APPLICAN
NAME: SIMSCROFT ECHO F LOCATION
ADDRESS: P O BOX 5810 AM
�' NE RS ROAD
SIMSBURY,CT 0607 1z, SKI MILDRED W
- Ng V RS ROAD
'
PHONE 860-651- 2 INDSOR,CT 06074
WORK DESCRIPTION: REPAIR -
PART OF VER R ERAL
THE DRAIN LAYER ASSIGNED TO THIS PC1�
THE TERMS AND CONDITIONS SET FORT £A TATE AND HEREBY AGREES TO ALL
THE TOWN OF SOUTH WINDSOR STAND RK SHALL BE IN ACCORDANCE WITH
A - IATTACHED CONDITIONS.
ISSUED BY DATE INSPECTED INSPECTED BY
7/30/2010 9:44 AM
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TOWN OF SOUTH WINDSOR INSPECTION:REPORT
PERMIT NO.:_16000L3?
CONTRACTOR: 5I M.5 G,60- f
LOCATION: eve .
TYPE OF WORK: C`►i -
�1���i—h^SPef�11 t�17✓IPc/
DATE INSP NEEDED: DATE INSP:
INSPECTED BY:
WORK IN
PROGRESS: «. , r -k- C 2 r► o`� �' P ire s D 2 3.5
J
SEPTIC TANK PUMPED, S ASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: f
DATE:
W12007 Town of South wndsor INPSECn0 N REPORT 07
Q9�CrCJaT1 •Zo I000964-
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: IS I e-OU5 #
Street No. Street Name
Premises owned by:_Ah'' 6mklsk;A�5/Ci
Name of Firm:-SW-ccro coo Fps T Phone: (o 667-0--23(
Address of Rrm:' Gpowr,A (A 0., 0.&L( `Si`+LsbvT, GT or;a?0
TYPE OF WORK:
Lay House Drain Repair House Drai
Lay Main Lay Lateral for Commercial/Industr al
Building of acres
Connection will be made with
Existing Water Supply: Public Water_ Well
Proposed Start Date
-&LVk10 Estimated time,for completion .1- O
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: Niy/d/ �;y'k1✓d the holder of Drain
Layer's License No. 2 -1!1 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. j52jc' - "Z,ZO- c9 ,b
Signed: G .�;�..�--� Print N ' L�• •
9 Name: � ti /
Licensed Drain Layer Coe
Date: 6 - /
Standard Forms\Permfts\APPLICATION FOR DRAIN LAYERS PERmrr.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATE RA'L--..-.'Fl E LD LOCATION
DATE OF CONSTRUCTION: $ /
BUILDING ADDRESS
STREET '000e'l
-�-- SUBDIVISION:
NORTH ARROW
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—V2
-74
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CONTRACTOR (PRINT). / NAME OF NTRACTOR'S SUPERVISOR (PRINT)
STREET ADDRESS SIGNATURE
DATE
TOWN - STATE ZIP INSPECTED BY TOWN
DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER