HomeMy WebLinkAboutDrain Layers Permits 9999 Dart Hill Road 1400029 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 08/08/2014
GIS ID:25809999 FEE: 0.00
MUNIS APPLICATION# 201401092 EXPIRATION DATE: 09/07/2014
APPLICANT LOCATION
NAME: GERBER CONSTRULI ON O, ADDRESS DAFT SILL ROAD
ADDRESS: 1 NUTMEG DRIVE QWNER TOWN OF SOUTH WINDSOR
ELLINGTON, CT 06624 154 SULIVAN AVE
-- pVINDSOR,CT 06074
PHONE 860 87 6684
WORK DESCRIPTION: DART HILL- 1 ECONSTRUCTION =TOWNPRflJE T
INSTALL A D REPAIR SEWERS PAR PROJECT REQUIREMENTS
THE DRAIN LAYER ASSIGNED TO THIS4'E IT HAS A VALID LjC--F- E ISSU II$Y THI STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORTH I1�THE ATTACKED C(&i51TIQNS-j ,AFL RK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDARDS,ALL OSHA REQUIREMEN j SrAND THE ATTACHED CONDITIONS.
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ISSUED BY i DOE INSP CT INSPECTED BY
8/8/2014 10:02 AM
APPLICATION FOR DRAIN LAYER PERMIT '� 0 Al Qooa9
TOWN OF SOUTH WINDSOR
44 RONO/090-1-1 PUBLIC WORKS DEPARTMENT
TOWN HALL T owl? P rV eG{
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT reLS U/� ,t/`'�
FEE $60.00
Location of proposed work: / Lot #
Street No. Street Name
Premises owned by: — Tvwn Dirt r e c--x 5,/r a c4i,
Name of Firm: � ''L. Phone:
Address of Firm:
l A 8° s�wt P�P r` 1vl I-t w p tiff H)/I k
TYPE OF WORK: io ? 99 d r�i ve wA
Lay House Dram ; Repair House Drain ;
Lay Main ; Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with
Existing Water Supply: Public Water l/ 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 the holder of Drain
Layer's License No. Z.6 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.
CBYD No.
Signed: Print Name:
Licensed Drain Layer
Date:
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc