HomeMy WebLinkAboutDrain Layers Permits 169 Maskel Road 1200050 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 09/18/12
GIS ID: 57900169
- � FEE: 60.00
MUNIS APPLICATION# 201201219y �_ EXPIRATION DATE: 10/18/12
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APPLICAN'L G y y 3 LOCATION
NAME: JAMES THROWE DB
%�1DDRES 1kl;&A KEL ROAD
ADDRESS: 97 RIVERSIDE DRIV V W %Wr
��' �E T�IPP LSLIE J
VERNON ROCKVIL A AL
I C E
J C AND RD RM 106
3 % � ��JT-ti INDSOR,CT 06074
PHONE 860-289695
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WORK DESCRIPTION: NEW SEWFCT
THE DRAIN LAYER ASSIGNED TO THIS RMI TVNI-1S A Y HE TATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORD ILA ," I�j�AI �VRK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDAI S �
�L OSHA � 1� A �H ATTACHED CONDITIONS.
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ISSUED BY D EC INSPECTED BY
9/18/2012 12:45 PM
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: , Q'�c�� CONTRACTOR:
LOCATION:____(�q
1
TYPE OF WORK:_ VI P(� �C�' Y-1 ec
DATFINSP NEEDED: -INSP:
INSPECTED BY:
WORK IN
PROGRESS:
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: DATE:
S/FORMS/TOWN OF SOUTM 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: !�� 02as,� j Lot#
Street No. Street Name
Premises owned by: ►(�tJ
Name of Frrn VQ ns r + c o t-o— TLC Phone: �r4t) criS
Address of Firm:m 1 1
TYPE OF WORK:
Lay House Drain : Repalr.House Drain
Lay Main ;_Lay I ateral for Commercia �nd�ctriar
Building �of acres
Connection will be made with S!�IC 3S
Existing Water Supply: Public Water Well
Proposed Start Date Estimated time for completion
ALL WORK TO BE IN ACCORDANCE WITH.TOWN OF SOUTH WINDSOR STANDARDS,
ALL OSHA_REQUIREMENTS AND CON 00NS ATTACHED TO THE PERMIT
Permit is to be issued to 192!�
s the holder of Drain
Layer's License No. �5� ., Only holders of P-1, P-7 or W-9 licenses
Will be issued a permit. PERMIT WILL EXPIRE THIRTY(30) DAYS AFTER
DATE DF 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.
PLEASE NOTE:
CBYD No. ni 3�oc) IFA SANITARYSEWER-LATERAL
IS WITHIN75 FEET OFA WELL
IT Ml1ST 5EAIR TESTED
Signed: Print Name: -�-
Licensed Drain Layer
Dater- I`Z.
Standard Farms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc