HomeMy WebLinkAboutDrain Layers Permits 1559 Sullivan Avenu (2) 1200021 TOWN OF SOUTH WINDSOR, CT
PENT NUMBER DRAIN LAYER PERMIT
DATE: 05/31/12
GIS ID: 87301559 - = - FEE: 60.00
MUNIS APPLICATION# 201200613 = EXPIRATION DATE: 06/30/12
APPLICANT -- LOCATION
NAME: SIMSCROFT ECHO FAR
MS = ADDRESS_:, I559=SULLIVAN AVENUE
ADDRESS: P O BOX 581 OSIER: KELLEYCAROL S
SIMSBURY,CT 06070 = 493ZC SEMARY LANE
Sf� JTH'WINDSOR,CT 06074
PHONE 860-651 023-1-
WORK DESCRIPTION: NEW SEWNWCONI-A&ffi = ,
THE DRAIN LAYER ASSIGNED TO THIS PERMIT"HAS A VAL L10ENSE ISSUED BY THE STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORTI ITI"TI- ATTA-c ;�I3`CON IT ONS . ALL WORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDARDS XLL-t OSHA RE-Oi 2E 4EN�Tii,"TTACHED CONDITIONS.
ISSUED BY DA E SPECTED INSPECTED BY
5/31/2012 10:46 AM
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: CONTRACTOR: .S
LOCATION: S S D
TYPE OF WORK: Y1 eL)o Ca n r e `o n
DATE INSP NEEDED: DATE INSP: r
INSPECTED BY: ,eb
WORK IN
PROGRESS: -
3��
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: YV. DATE: V
W/2007 Town of South Windsor INPSECTION REPORT 07
APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
1540 SULLIVAN AVENUE
PUBLIC WORKS DEPARTMENT
TOWN HALL
SOUTH WINDSOR, CT
FEE $60.00
Location of proposed work: �.SS �S"v//i�.�h ,�,t Lot #
Street No. Street Name
-Premises owned by:_ O Cy-l� 6n d. -
�,6„ 6 V
Name of Firm: 3,,, G�� Phone:
Address of Firm;42t.� ,w. G,,�,1 �. (?�,
TYPE OF WORK:
Lay House Drain • Re it House Drain
Lay Main La Lateral r merciai/Industria
Building v of acres
Connection will be made with /rvA rs I,-
Existing Water Supply: Public Water Well
Proposed Start Date - y/ Estimated time for completion - 0'
/M
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 .S% t�h older of Drain
Layer's License No.v[rK. oa o&3 P7. Only holders of P-1Jlt'�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.. Ap li ece_lved
Town Street Excavation Permit No. and/ ConnDOT Permit 1 0.
d1oT �Da 96 71
PLEASE NOTE:
CBYD No. _ dl /7Do 6!y' IFA SANITARYSEWER-LA TERAL
IS WITffIN75 FEET OFA WELL
ITMUSTBEAIR TESTED
Signed:_ Print Name: kn�,ti
Licensed Drain Layer
Date: s-3i- Roi2
Standard Forms\Pennits\APPLICATION FOR DRAIN LAYERS PERMIT.doc
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