HomeMy WebLinkAboutdrain layer permit 595 Nutmeg Road 1100008 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
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DATE: 03/23/11 �� ' - -
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GIS ID: 65100595 % FEE: 60.00
MUNIS APPLICATION# 201100204 � � EXPIRATION DATE: 04/22/11
APPLICAN = �Jo-
: LOCATION
NAME: ENVIRONMENTAL S CAS '
R rN RE SUMEG ROAD
ADDRESS: 90 BROOKFEILD ST = ; j ROS COMPANY
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SOUTH WINDSOR,� ��4 y f -A $OU HHAMPTON ST
NOW o of %�� -VUS MA 02118
PHONE 860-528 500; �� - r
WORK DESCRIPTION: BULK HI No, '0 i
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THE DRAIN LAYER ASSIGNED TO THIS R*- T k A,- 7oSU �' STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORT �N Tl VRK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDARS�ADS Q � E1vk�A"T-A ATTACHED CONDITIONS.
ISSUED BY DATh IN PECTED INSPECTED BY
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: 11060og CONTRACTOR: Vi�On✓h�/Ifa.� yl �S
LOCATION: U y}')pCj I�OIp
TYPE OF WORK: 6 LL I)/- �ef De rn o f�/
DATE INSP NEEDED: DATE INSP: 312 3//.,
INSPECTED BY: s.D
WORK IN
PROGRESS: '.4 cc w, -� 4 zncam,keJ
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: DATE:
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: 95 N v Lot #
Street No. eet Nigne
Premises owned by: ILou.
Name of Firm: Lc-W Ot26 0,M f A f n( 56-2 u)c�z Phone: 96o 5A q
Address of Firm: ` 0 fJ2o0� Ct c ko 1�6 0)-0 5-4 4- Cq 0 07�
TYPE OF WORK: (J C jC. C-1�crQO �cw�✓!/ ����"p I3 c/i too
Lay House Dram ; Repair House Drain ;
Lay Main ; Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with �J V
Existing Water Supply: Public Water Well
Proposed Start Date 3 Estimated time for completion a S //
ALL WORK TO BE IN ACCO DANCE WITH TOWN OF SOUTH WINDSOR ST DARDSI
ALL OSHA REQUIREMENTS AND CONDITIONS ATTACHED TO THE PERMIT
Permit is to be issued to tM 1(_ 4 1=1 P the holder of Drain
Layer's License No. ao-) Q 5 4 . . Only 6olders of P-1.Ej 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. o l.j 0!100 �2, .
- --Signed: -- - - - - Print-Name:
ens Drain Layer
Date: 3
Standard Form Permits\,APP CATION FOR DRAIN LAYERS PERMIT.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIE LD LOCATION
DATE OF CONSTRUCTION: 3 l
BUILDING' ADDRESS
STREET
SUBDIVISION:
E,ws�n1 KE4-M4 535q
NORTH ARROW
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CONTRACTOR (PRINT) NAME OF C NTRACT S SUPERVISOR (PRINT)
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STREET ADDRESS SIGNATURE
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TOWN STATE ZIP INSPECTED BY TOWN
DATE
TELEPHONE NUMBER
WHITE -'TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER j DEVELOPER