HomeMy WebLinkAboutdrain layer permit 2600 Tamarack Avenue 1000056 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER
DRAIN LAYER PERMIT
DATE: 10/26/10
GIS ID:89302600 ,
MUNIS APPLICATION# 201001456 FEE: 60.00
EXPIRATION DATE: 11/25/10
APPLICAN LOCATION
NAME: SIMSCROFT ECHO F S
ADDRESS: P O BOX 581 RE T ARACK AVENUE
Ail
SIMSBURY,CT 060 - g: EN MEDICAL ASSOCIATES LLC
FIS R DRIVE
PHONE 860-651 ( 06001
WORK DESCRIPTION: NEW SE
THE DRAIN LAYER ASSIGNED TO THIS
THE TERMS AND CONDITIONS SET FOR ISU TATE AND HEREBY AGREES TO ALL
THE TOWN OF SOUTH WINDSOR STAND RK SHALL BE IN ACCORDANCE WITH
AST ATTACHED CONDITIONS.
010 / 0 SO
ISSUED BY -
10/26/2010 3:44 PM DATE INSPECTED INSPECTED BY
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: CONTRACTOR:
LOCATION: oR 600 van GtI� C
TYPE OF WORK: P CQ S2 - c'-c6A
DATE INSP NEEDED: DATE INSP:
INSPECTED BY:
WORK IN
PROGRESS:�'�0�f-c -� �r PyG s t
To B� IA5;11! o-IL `F5'be bQfor_. conngiina 1-o U PirC sr-H YO
k3% Farr.CO Crw C �a.�✓•C $ � �.�-
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: DATE: 1 D �a 0 1 10
S/FORMS/TOWN OF SOUTH WINDSOR INSPECTION
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: k 00 Lot #
Street No. Street Name
Premises owned by:---C '
Name of Firm: Si yAscV6-r--4' Phone: 3�a
Address of Flrm: AVY1,58 C
TYPE OF WORK:
Lay House Drainer Repair House Drain
Lay Main • Lay Lateral for Commerdal/Industrial
Building of acres
Connection will be made with t�U
Existing Water Supply: Public Water I Well
Proposed Start Date-1 2 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 to 9U 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.
Signed:-.9 Print Name: -
Licen se
Drain Layer
Date: 1 D -d(o -/Q
sw eard FWw\Permits\APPLICATION FOR DRAIN LAYERS PERMrr doc
TOWN OF SOUTH WINDSOR
SANITARY" ,SEWER LATERAL FIELD LOCATION
DATE. OF CONSTRUCTION:
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CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPERVISOR,(PRINT).
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STREET ADDRESS SIGNATUR
,� f0 7//O DATE
TOWN G STATE ZIP INSPECTED BY TOWN
D L0.�0 2?� DATE
TELEPHONE NUMBER
WHITE — TOWN PINK — CONTRACTOR YELLOW — CONSULTING .ENGINEER / DEVELOPER