HomeMy WebLinkAboutDrain Layers Permit 64 Bancroft Lane 1100007 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 03/22/11
GIS ID: 07200064 A FEE: 60.00
MUNIS APPLICATION# 201100199 =�� —� EXPIRATION DATE: 04/21/11
o
APPLICANT LOCATION
NAME: LONDO PLUMBING im RED 64 B�ANCROFT LANE
ADDRESS: 512 HAZARD AVENiFX` � tILLC
ENFIELD,CT 06082 3L RD
_ SOR CT 06074
�" BIND
PHONE ;
� �ii
WORK DESCRIPTION: NEW SAEO'%
THE DRAIN LAYER ASSIGNED TO THIS 1R*-f kkiA IgnSU1YTATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORT & A H1L �RK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDARD tLO QlREMFT ATTACHED CONDITIONS.
� ;
ISSUED BY DATE INSPECTED INSPECTED BY
3/22/2011 2:58 PM
-09
' _
F 5s07
s �
i I
ey
�.
i wim
ice , ;
-gog
fffl
y
` i - /
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: I1OX07 CONTRACTOR: La d PJ
LOCATION: Co C Y? C Y-0 * 1 ,t i`c
TYPE OF WORK: M4) Set'oev C,o vi tryec ^T 1 b
DATE INSP NEEDED: DATE INSP: �
INSPECTED BY: (So
WORK IN
PROGRESS:
�a° 6«ss
// Se`k j
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT:_ DATE:
S/FORMS(TWN 01 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: c zn h Lot #
Street No. treet Name
Premises owned by:
Name of Firm: Phone: P10JY1 r'O
Address of Firm: siz �'� 6.09
TYPE OF WORK:
Lay House Drain_; Repair House Drain ;
Lay Y Main • La Lateral for Commercial/Industrial
Building of acres
Connection will be made with
Existing Water Supply: Public Water-/LO, Well
Proposed Start Date 2z Estimated time for completion 5L2 2
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 1-i,?::Q 4 z c` the holder of Drain
Layer's License No. 62,ej 4o3 — p,1 . 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.
t
Signed: tz Vh ul Print Name: P/R o I� el o
_
Licensed Drain Layer
Date: 3/Z Z/r 1
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc
TOWN OF -SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: �- 1
BUI
LDING ADDRESS
STREET- � l>
SUBDIVISION:
NORTH ARROW
4_�..
3 rr M
i Li
viol
f
j
I
!
i
4
0-nCA FT
/ �Iq0 .t
CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPERVISOR (PRINT)
SOZ c� cwP 70 ce
STREET ADDRESS SIGNA
� 06
ATE
TOWN STATE ZIP INSPECTED BY TOWN -
7/7 63 DATE
TELEPHONE NUMRER
WHITE — TOWN PINK - CONTRACTOR YELLOW — CONSULTING ENGINEER / DEVELOPER