HomeMy WebLinkAboutDrain Layers Permits 140 Lawrence Road (2) 1200038 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 08/01/12 %
GIS ID: 52800140 0� - FEE: 60.00
MUNIS APPLICATION# 201200997 �� s EXPIRATION DATE: 0$/31/12
AN
APPLICANT- G ppn OCATION
NAME: BARBER UTILITIES LffC, A DDRESI, RENCE ROAD
ADDRESS: 35 PINNACLE ROAfil D '
QILEAt NICOLE C
ELLINGTON, CT 0609 � „�14@ VRENCE ROAD
III'FFI V INDSOR CT 06074
PHONEall lk�
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WORK DESCRIPTION: NEW SE COI T '--
THE DRAIN LAYER ASSIGNED TO THIS RI TVAS A E HE STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORTS IXHI - aNs=AI2K SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDAhS��1I .,OIA -- TTACHED CONDITIONS.
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ISSUED BY DATE INSPECTED INSPECTED BY
8/1/2012 9:01 AM
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: Za 6003 CONTRACTOR: &oi"or I A 1�t r° C
LOCATION: ,T_lat4it� hG
TYPE OF WORK: Cp vi nec t on
DATE INSP NEEDED: DATE INSP: 8 / /Z
INSPECTED BY: 9b
WORK IN
PROGRESS: ;A yQ&J_ 6 "' Pit c- SOX
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SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED YES ❑ NO
AS-BUILT: [/
INPUT: Ci DATE:
S/FORMS/TOWN OF SOUTH WINDSOR INSPECTION
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: l`() s i Lot #
Street No. Street Name
-Premises owned by:
Name of Firm.-_F L/ 63 Phone:
Address of Firm: 'P, a� `3 3 , C--LL r/y-& �N
TYPE OF WORK:
Lay House Drainer Repair House Drain-
Lay Main _,;___; Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with r S DX 3 5-
Existing Water Supply: Public Water Well
Proposed Start Date S- /-/2 Estimated time for completion oAe- P,,f7
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—L*v(o E, S7-fi-4,txu5 the holder of Drain
Layer's license No. 02.1613 S41- V7 .. 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 theMto. Applicant has received
Town Street Excavation Permit No. and/or ConnDOT Permit No.
CBYD No. Zoe Z 31 o v 633 PLEASE NOTE:
IFA SANITAR Y SEWER LATERAL
IS WITffIN75 FEE T OF WELL
IT MUST HEAIR TESTED
Signed:--.kz Print Name: &Wt D 7 `
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Licensed Drain Layer
Date: e-�- 1 Z
Standard Forms\Permits\APPUCATION FOR DRAIN LAYERS PERMIT.doc
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