HomeMy WebLinkAboutdrain layer permit 96 Tumble Brook Drive 1000062 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
3
DATE: 11/22/10
GIS ID:90600096
FEE: 60.00
MUNIS APPLICATION# 201001573 k n r r EXPIRATION DATE: 12/22/10
APPLICANT'
,LOCATION
NAME: LANDIE CONSTRUC Ip 4INC ADDRESS w 96,TUMJ!BROOK DRIVE
ADDRESS: 21 CLARK ROAD () R KING(rREGORY D&ELLEN D
BOLTON,CT 06043 96 TUMBEBROOK DRIVE
s
'< OUTH VE INDSOR,CT 06074
PHONE 860-646 80,§, 1Y — a
WORK DESCRIPTION: 1NSTALL� ATIT�AIZ�',SEWRI�ATL
THE DRAIN LAYER ASSIGNED TO THIS PENT BIAS A�AI�LIEI1~ISSUF�D BY THE STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORTHw T4�TTACHE `'GONI�ITI NS' L VRK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDARDSy ? p�H ItEQIES, AND TOTE ATTACHED CONDITIONS.
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ISSUED BY IJATE INSPECTED INSPECTED BY
11/22/2010 2:00 PM
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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:__Z�,/ram Atz _Lot #
Street No. 1Street Name
Premises owned by: �cli � �
-At s46 Name of Firm: el� Phone: -7f55f ' ��':I, 1i
Address of Firm:. Z !
TYPE OF WORK:
Lay House Drain ; Repair House Drain ;
Lay Main ; Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with
Existing Water Supply: Public Water_ Well
Proposed Start Date-IL11-M)Estimated time for completion 2 �S
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 �A 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. ZO
Signed: �/c Print Name:
Licensed Drain Layer
Date:
Standard Forms\Permlts\APPLICATION FOR DRAIN LAYERS PERMIT.doc
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: CONTRACTOR: en
LOCATION:_
TYPE OF WORK:_
DATE INSP NEEDED: DATE INSP:
INSPECTED BY: 6'- '/,o
WORK IN
PROGRESS: �' ��� ��� �� � a z xr -11,1 i hi kt-ed frees
�A
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES
10
AS-BUILT: 1
INPUT: C1� DATE: I '
S/FORMS/TOWN OF SOUTH WINDSOR INSPECTION
TOWN OF SOUTH ANDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS : _ q
STREET . �1�"S,�'��e-
+ SUBDIVISION:
NORTH ARROW
GL ray i
Xt A.4
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z
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CONTRACTOR (PRINT) NAME OF CO CTOR'S SU OR (PRINT)
STREET ADDRESS SIGNATURE
y �'j DATE
TOWN STATE ZIP INSPECT D BY TOWN
DATE
TELEPHONE NUMRER -
WHITE — TOWN PINK — CONTRACTOR YELLOW — CONSULTING .ENGINEER / DEVELOPER