HomeMy WebLinkAboutdrain layer permit 2155 Ellington Road 1000058 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 11/01/10
GIS ID:30302155 FEE: 60.00
MUNIS APPLICATION# 201001,168 EXPIRATION DATE: 12/01/10
APPLICANT ; LOCATION
NAME: BARBER UTILITIES LLC, ADDRESS:- 2, SS EdiR6TON ROAD
ADDRESS: 35 PINNACLE ROAD OWNER DEPENDABLE CONSTRUCTION LLC
ELLINGTON,CT 06029 . . 1 RIVER PARK
CROWLL,CT 06416
PHONE
WORK DESCRIPTION: NEW SEWER`CONNECTION
THE DRAIN LAYER ASSIGNED TO THIS PERMIT HAS A VALID LICENSE ISSUED�BY TFfE STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORTI�IN"THF ATTACHED`CONDITIONS'-- ALL WORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDARDS;ALL OSHA REQUIREMENTS,AND THE ATTACHED CONDITIONS.
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ISSUED BY DATE INSPECTED INSPECTED BY
11/1/2010 12:32 PM
TOWN OF SOUTH WINDSOR INSPECTION REPORT
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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: 15'5 tz:1Wr' +0rN ao. Lot #
t,
Street No. Street Name
Premises owned by:
Name of Firm:_ 3d�_6c� 61227LI726-3 4-C-C Phone: gbo--j9712L2 34-9
Address of Firm:`
TYPE OF WORK:
Lay House Drain ; Repair House Drain ;
Lay Main ; Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with 50Lr d Pr P S1,)4 3s
Existing Water Supply: Public Water Well
Proposed Start Date 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 toy U'71L('77675 Z-L C the holder of Drain
Layer's License No. f92-7 R3�2 M . 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. Print Name:_ ) L L)
Licensed Drain Layer
Date:— Oci 30 do 10
Standard Forms\Pennits\APPLICATION FOR DRAIN LAYERS PERMIT.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: _A
BUILDING ADDRESS
STREET
SUBDIVISION:
NORTH ARROW
�T
CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPERVISOR:(PRINT)
STREET ADDRESS SIGNATURE
DATE
TOWN STATE ZIP INSPECTED BY TOWN U `7 ® DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW -' CONSULTING ENGINEER / DEVELOPER