HomeMy WebLinkAboutDrain Layers Permits 40 Kennedy Road (2) 1200007 = TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 03/06/12 �£ �
GIS ID:49800040 % s -r FEE: 60.00
MUNIS APPLICATION# 201200207 EXPIRATION DATE: 04/05/12
APPLICANT LOCATION
NAME: FOLSOM CONSTRUCTION IC � ADDRES ; g.EDY ROAD
ADDRESS: 138 RYE STREET a Ei CK FF VE LLC
SOUTH WINDSOR, 0 s y A ROAD
26
y TNDSOR,CT 06074
PHONE 860-528-1 �-
WWI, � -
WORK DESCRIPTION: INSTAL14901til-C"ATI-1 NHOLES
FED EX
THE DRAIN LAYER ASSIGNED TO THIS E 1
L IASa A7 y '3I I- LATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FOR - u - �, `C IbN- A ZK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDAr<QSo OIIA ' ATTACHED CONDITIONS.
ISSUED BY DATE INSPECTED INSPECTED BY
3/6/2012 2:48 PM
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMITNO.: - l a 0000 '7 CONTRACTOR: "L IsaVm
LOCATION:
-TYPE OF WORK:_ Swe C \ ►ems
DATE INSP NEEDED: DATE INSP: '2-
INSPECTED BY:_&b.
WORK IN
PROGRESS: 3/r4 s4,.Jz.,l s Ar "e
Te i�
SEPTIC TANK PUMPED,SMASHED, FINED WITNESSED El YES ❑ NO
'AS-BUILT.-
INPUT: DATE: 11
W12007 Town of South Windsor INPSEC UON REPORT 07
APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
1540 SULLIVAN AVENUE
PUBLIC WORKS DEPARTMENT
TOWN HALL
SOUTH WINDSOR, CT
co-TWT'a-to-4 606ZZ( FEE $60.00
.Location of proposed work:
Street No. Stfeet Name
Premises owned by:
Y
Name of Firm: Phone:
Address of Rirm:
TYPE OF WORK:
Lay House Drain_; Repair House Drain ;
Lay Main ; Lay Lateral for Commercial/Industrial
Building of acres
fl
Connection will be made with Ae
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 frl.� 6�C the holder of Drain
Layer's License No.rk� �0 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.
� �d��s/ PLEASE NOTE:
CBYD No. l a' IFA SA NITA R Y SEWER LATERAL
IS WITHIN 75 FEET OFA WELL
IT MUST SEAIR TESTED
2
Signe /9� Print Name: /3a2c.,
ice sed rain Layer
Date:
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc