HomeMy WebLinkAboutdrain layer permit 1 Vibert Road 900046 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER
%% _ DRAIN LAYER PERMIT
DATE: 07/15/09
GIS ID:91800001
MUNIS APPLICATION# 200900813
` �� FEE: .00
W�
APPLICA XPIRATION DATE: 08/14/09
NTS
NAME: C H NICKERSON ANDQ
OCATION
ADDRESS: 49 HAYDEN HILL ROD ' S' # I OAD
P O BOX 808
_� - W?I T�ITDSOR TOWN OF 65
TORRINGTON,CT 0619
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_ RTAD
PHONE INDSOR,CT 06074
WORK DESCRIPTION: SEWER INTA- TIt j�OR N ='
TOWN PRO ATrTI�L .NT
FED
THE DRAIN LAYER ASSIGNED TO THIS PE t
� IA YALID E ISSUEI�YY
THE TERMS AND CONDITIONS SET FORTH ATE AND HEREBY AGREES TO ALL
I T E��h- = ITIO AL
THE TOWN OF SOUTH WINDSOR STANDARDS ISO SHALL BE IN ACCORDANCE WITH
' M T ATTACHED CONDITIONS.
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ISSUED BY -�J
DATE 7/15/2009 11:11 AM INSPECTED INSPECTED BY
TOWN OF SOUTH WINDSOa INSPECTION REPORT
PERMIT NO.: (� CONTRACTOR: C
LOCATION: �/ e
'TYPE OF WORK: to
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�___.._ --DATE INSP NEEDED:
DATE INSP: / L r
INSPECTED BY:-13 D
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PROGRESS:
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INPUT:_ DATE:_
W/2007 Town of South Windsor INPSEMON REST 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: At �� Lot #
Street No. Street Name
Premises owned by: ,S• e v,o
Name of Firm:_ C,h'. ;, ��,rr',� ,� �o =Kc Phone:
Address of Firm:_ Pe2. , x �P T r,N, ��N , G%.
TYPE OF WORK:
Lay House Drain Repair House Drain ;
Lay Main ; Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with _ FV C-
Existing Water Supply: Public Water ✓ Well
Proposed Start Date /,0 Estimated time for completion . W
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 '8_ " the holder of Drain
Layer's License No. . my 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. 4- 23a-2so�
Signed:- S��H
9 -Print Name:_ lei
'censed Drain y r
Date: &PUCATION
Standard Fom4permi FOR DRAIN LAYERS PERMIT.doc