HomeMy WebLinkAboutDrain Layers Permits 173 Frazer Fir Road (2) 1300014 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 06/27/2013 �/�
GIS ID:34430173 FEE: 60.00
MUNIS APPLICATION# 201300890 - y
IN
/ - EXPIRATION DATE: 07/27/2013
IMMUNE
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APPLICANT %- ggg
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NAME: EAGLE EARTHWORI U RE MkVER FIR ROAD
ADDRESS: 101 N MOUNTAIN RdA INO BUILDERS INC
CANTON CT 06019
'= �#I? I A'EL ROAD
PHONE 860-693-2027 -
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WORK DESCRIPTION: NEW SE*
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THE DRAIN LAYER ASSIGNED TO THIS ITT ti-AS A ISSUE TATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORT T Iy 1 A 110 70 SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDAR 2?rL OSF& Q A � A 2 ATTACHED CONDITIONS.
ISSUED BY DATE NSPECTED INSPECTED BY
6/27/2013 9:51 AM
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: GD) CONTRACTOR: Q S le. Ca rrh wy r4-
LOCATION:
TYPE OF WORK: <-g f AleC �b rr Vln Lin Y�
DATE INSP NEEDED: DATE INSP-
INSPECTED BY: ,-
WORK IN
PROGRESS: Wd
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT: z/
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 proposed work: f2 3 {r Zr`-ey l -b 1.ot# �
Street No. StreetName
Premises owned by:
Name of Fi ne: �?
Address of Firm: t ItiI r� Drti ''� lia
TYPE OF WORK. :
Ley House Drain-'; Repair House Drain
Lay 1Ma1n ; Lay Lateral for Commeraal/Industriat
Building of ad es -
Connection will be made with
Existing Water Supply: Public Waterer Well
Proposed Start Date Estimated time for completion
ALL WORK TO BE IN ACCORDANCE WITH,TOWN OF SOUTH WINDSOR STANDARDS,
ALL OSHA.REQUIREMENTS AND CONDMONS ATTACHED TO THE PERMIT
Permit is to be issued W j01444el 4�e off_the holder-of Drain
Layer's License No. - 7 ),d _• Only holdbf P-I, P-7. or W-9 licenses
Will be issu p1permit. PERMIT WILL EKP RE'€ [1 'I'1f(30) DAYS AFTER
DATE OF ISSUANCE. The undersigned Drain Layer hereby agrees to all the terms
. and conditions set for&in the.p it and attached thereto.. Applicant has'reCelved
Town_Street Excavation Permif Na and/or ConnDOT Permit No.
PLEASE NOTE
CBYD No. lFA SANITARYSMVER LATERAL
IS WITHrN75FEET OFA wa
IT/MUST wAfR Tes'TEO
Signed: /00's' not Name: t Q 7
Licensed Drain Layer
Date: Ir' - �4I
Standard'Forms\Permits\APPLICATION FOR DRAIN LAYERS PERM1T.doc JJ
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TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD - LOCATION
DATE OF CONSTRUCTION: ��-r -C_
BUILDING ADDRESS
STREET :
SUBDIVISION: e"iL'
i
NORTH ARROW
i ?l 7
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77-11
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CONTRA OR (PRINT) / 7AME" CONTRACTOR'S S PERVISO (PRINT)
NEEf ADDRESS SIGNATURE
DATE
TOWN TATE ZIP INSPECTED BY TOWN
fiOr '��c aC DATE
TELEPHONE NUMBER
WHITE — TOWN PINK — CONTRACTOR YELLOW — CONSULTING ENGINEER / DEVELOPER