HomeMy WebLinkAboutdrain layer permit 299 Strong Road 1100013 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
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DATE: 04/18/11 —/'= ' r
GIS ID: 87000299 1& � "'�� FEE: 60.00
MUNIS APPLICATION# 201100302 y EXPIRATION DATE: 05/18/11
APPLICAN'lif ��,�� � %LOCATION
NAME: JAMES THROWE DB RES y 2 9�97A ROAD
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ADDRESS: 97 RIVERSIDE DRIVI I HT&POWER CO
VERNON ROCKVILI. ,�T 66 / = SELIN STREET
M94 �
T 06037
PHONE 860-289 6095- y
WORK DESCRIPTION: REPAIR PT1S�I1
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THE DRAIN LAYER ASSIGNED TO THIS 1 R&1 1.A 4SISU 0-- Y it TATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORT -Wj&K SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDAR66- Oi M Alm TIATTACHED CONDITIONS.
ISSUED BY DATE INSPECTED INSPECTED BY
4/18/2011 8:08 AM
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: /voo/a CONTRACTOR: I IA"--s
LOCATION: S
TYPE OF WORK: m
DATE INSP NEEDED: DATE INSP:
INSPECTED BY: a D
WORK IN
PROGRESS: CoAv&Je,r (zU(c/_cg � i;I-cs on Po.M6 ` pL' k"
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: PL- DATE:
W/2007 Town of South Windsor INPSEC11ON REPORT 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: ?
St
reet No. Str et Name
Premises owned by: k
Name of Firm:___�An5 �e,. �X -iyic�4LCPhone: 2b�5'Gv9S'
Address of Firm: 7 I )14t=5J-A— r4 d
TYPE OF WORK: ,'r,PU '/3 S,�,,,n
Lay House Drain ; Repair House Drain ;
Lay Main ; Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with L/0 a
Existing Water Supply: Public Water Well_
Proposed Start Date/a*L /l Estimated time for completion I.MoR >>
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 r-,-� _ the holder of Drain
Layer's License No. D&F6 i 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:
9 G al,
7 Licensed Drain Layer
Date: IS APR
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc
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TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION:
BVILDING ADDRESS
STREET -.
SUBDIVISION:
NORTH ARROW
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64
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CONTRACTOR (PRINT) T� NAME OF CONTRACTO 'S SUPERVISOR (PRINT)
STREET ADDRESS SI RE
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TOWN STATE ZIP INSPECTED BY TOWN
DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW CONSULTING ENGINEER f DEVELOPER