HomeMy WebLinkAboutdrain layer permit 9999 Frazer Fir Road 1000046 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER I'llDRAIN LAYER PERMIT
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DATE: 09/07/10r3c
GIS ID: 34439999 v "G =- FEE: 60.00
MUNIS APPLICATION# 201001172
d_0040ANWN � - EXPIRATION DATE: 10/07/10
APPLICAN' LOCATION
NAME: BARBER UTILITIES LAC RE FRS EIFIR ROAD
ADDRESS: 35 PINNACLE ROAD Offy = � "� V� SOUTH WINDSOR
ELLINGTON,CT 060 9 4O�,SULlIVAN AVE
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�fJFVINDSOR,CT 06074
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WORK DESCRIPTION: SEWER W �A i3L N� (53 I ISION PHASE II
THE DRAIN LAYER ASSIGNED TO THIS ftRW HAS A V_;, ISmUb Y F TATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FOR74WfE-A � ITI4z SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDARIi-AID Q� E AITIIATTACHED CONDITIONS.
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ISSUED BY ATE INSPECTED INSPECTED BY
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: /0000 CONTRACTOR: Sy Q 4 bee 647-! ae-
LOCATION: Eaq L eiz
TYPE OF WORK: SC�A),o_C *�a\n ^1 VAS-#G lkq�6 L.
DATE INSP NEEDED: DATE INSP:
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INSPECTED BY: 2,0
WORK IN
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PROGRESS: 5.,,,., ��,a.,► F,n �6,�. -E-o rlw.. ,?�r /19�dred
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SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: DATE:
S/FORMS/TOWN OF SOUTH WINDSOR INSPECTION
APPLICATION FOR DRAIN LAYER PERMS
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $60.00
#3441 Location of proposed work: 1115 AM93L Yi jeoftv Lot #
Street No. Street Name
Premises owned by:
'�< 61 6 Name of Firm:- C am" 0;)L i 77&5 LL c� Phone: 7-3S 0 �fF
-sZO 65 33 rxZt
Address of Firm: 3 PwIyItc e-6 1 -01W &�L /A.A.✓a T
TYPE OF WORK:
Lay House Drain_ ; Repair House Drain ;
Lay Main • Lay Lateral for Commerdal/Industrial
Building of acres
Connection will be made with S cZvfX- Soa
Existing Water Supply: Public Water > Well
Proposed Start Date 6-3v-1 o Estimated time for completion C A)6 Liv u 7-f
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 -WiO St—RV6X2 S lder of Drain
Layer's License No. Q 276 3 5 1-- P 7 . Only holders of P-1 77� r 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. '3 5,03 5"
. via. 5� S.
Signed. Pant Name: yA
Licensed Drain Layer
Date: B-Z7- /o
Standard Forms\Permits\APPUCATION FOR DRAIN LAYERS PERMIT.doc