HomeMy WebLinkAboutdrain layer permit 100 Griffin Road 1100012 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 04/06/11 `=
GIS ID: 3900L001 ///' - FEE: 60.00
MUNIS APPLICATION# 201100242 y EXPIRATION DATE: 05/06/11
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APPLICAN ff
�� � LOCATION
NAME: ENVIRONMENTAL SIR DRE 0001 GA-IFFIN ROAD (100)
ADDRESS: 90 BROOKFEILD ST1E
�UfT" E L DUSTIN(REF.ONLY)
SOUTH WINDSOR,Gff--14 - 68 51
lawlWary it / Z3UTIINDSOR,CT 06074
PHONE 860-528-9500
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WORK DESCRIPTION: NEWR IEC�ION
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APPLICANT AGREES TO FURNISH THE TQW O JTPI= _AMO �'� ND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANIPICU� �TTE �7WIT772 MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THEOI ANT FAIVIAI ARbL
LL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF SO_
JTH Rp9RfSTMOTICUT PE TIT MANUAL.
ISSUED BY DATE INSPECTED INSPECTED BY
4/6/201112:46PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN Of SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: U D0 CONTRACTOR:
LOCATION: ) ( ,O k4- n ( L oo,
TYPE OF WORK: Leu) Sek'oe�- co rr'ec�� n
DATE INSP NEEDED: DATE INSP:
INSPECTED BY: g�
WORK IN
PROGRESS: (,044� vr _re54J/&J &'PVC SD2 39 SM a
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SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: L DATE:
W/2007 Town of South Windsor INPSECTION 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: C2i r-r,,,) kO Lot #
Street No. Street Name
Premises owned by: ��f►� ��o `�l l
Name of Firm: C-/ )UteoA)ynL5 ex)�4� c. Phone: R6 0 5d FA5vo
Address of Firm: qO &P-ooi ��lit Sf S-� (�►�os�ti C
TYPE OF WORK: / .
Lay House Drain , Repair House Drain
Lay Main ; Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with 191,1 G
Existing Water Supply: Public Water y Well
completion
Proposed Start Date c Estimated time for omp on
ALL WORK TO BE IN ACC RDANCE WITH TOWN OF SOUTH WINDSOR STANDARDS,
ALL OSHA REQUIREMENTS AND CONDITIONS ATTACHED TO THE PERMIT
Permit is to be issued to Co octis t the holder of Drain
Layer's license No. Only holders of P-1,97 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 aU the terms
and conditions set forth in the permit and attached thereto. Applicant has received
Town Street Excavation Permit No. and/or ConnDQT Permit No.
CBYD No. C22 I l 03ap
Signed: Print Name: ✓1 c,�
Lie rain Layer
Date:
Standard Forms\Permi \APPLI TION FOR DRAIN LAYERS PERMIT.doc
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