HomeMy WebLinkAboutDrain Layers Permits 40 Kennedy Road 1200060 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 11/15/12 le �
GIS ID:49800040 FEE: 60.00
MUNIS APPLICATION# 201201344 ' EXPIRATION DATE: 12/15/12
ME
APPLICAN � LOCATION
NAME: FOLSOM CONSTRUC;W C - RE_- � N 1EDY ROAD
ADDRESS: 138 RYE STREET ' N #WINDSOR LLC
SOUTH WINDSOR,(� `� I 1 CAI NEGIE BLVD#180
TE'NC 28209
: v h
PHONE 860-5281I9r. — 3 >-
g
g ,
' jr
lg
WORK DESCRIPTION: NEW SEA / TI
� Al
THE DRAIN LAYER ASSIGNED TO THIS AE R T HAS A- Amu ' TATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORTES_ I TjF WI2K SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDARb� AL �SHAI TIATTACHED CONDITIONS.
w ; _ ys
t -oC,
ISSU D BY DATE INSPECTED INSPECTED BY
11/15/2012 10:46 AM
�g
Air
r �
g
1ffy / s.1 s s
a
opi 4y y
y
siy ' Gs 9 �
,, s o g
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: la 04P6p CONTRACTOR:
LOCATION: b ILQ hYL
TYPE OF WORK: VICE w--ON- 140O K r
DATE INSP NEEDED: DATE.INSP: ��z
INSPECTED BY: Q-b
WORK IN
PROGRESS:
4-v lvcgl— oe crP Ste, v � )red-ex 6 r,,, !
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: ' 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 work: 4 �-e^&.t64Lot #
proposed
Street No. S t Name
Premises owned by: C5010 oft4 age �j ICY
Name of Firm: Phone:
Address of Firm: �f 0
TYPE OF WORK:
Lay House Drain_; Repair House Drain
Lay Main.; Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with �w
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 CONDITIONS ATTACHED TO THE PERMIT
Permit is to be issued to j,1�V-`so�r dwy4-we LLC--the holder of Drain
Layer's License No. 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.
PLEASE NOTE:
CBYD No. IFA SANITARYSEWER LATERAL
IS N/ITHrN75 FEE T OF WELL
IT MUST BEAIR TESTED
Signed: Ke Print Name:
Date:
Standard For nAPermits\APPLICATION FOR C?RAIN LAYERS PERMIT.doc