HomeMy WebLinkAboutdrain layer permit 51 Joseph Lane 1000016 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 05/04/10
GIS ID:48000051 4ys
r f FEE: 60.00
MUNIS APPLICATION# 201000504 - EXPIRATION DATE: 06/60.00
APPLICAN OCATI N
NAME: SKIPS SEPTIC
s � 'NOSE LANE
ADDRESS: 6 NUTMEG DRIVE ATTHEW B&MELISSA A
P O BOX 29 I � � CEPI LANE
ELLINGTON,CT 060 9 e_� ITl
= %
PHONE 860-875 _ VINDSOR,CT 06074
WORK DESCRIPTION: NEW SE
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THE DRAIN LAYER ASSIGNED TO THIS P AS A, - I N T �TATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORTH s 1 CH " TI RK SHALL BE ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDARD
� ;" 3 S T 5 ATTACHED CONDITIONS.
ISSUED BY DA PECTED INSPECTED BY
5/4/2010 10:14 AM
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TOWN OF SOUTH WIN'DSOR INSPECTION REPORT
PERMIT NO.: /0000 / CONTRACTOR: i S
LOCATION: J C?SPyo ( a
TYPE OF WORK: _ P
DATE INSP NEEDED: DATE INSP: (a
INSPECTED BY: 61P
WORK IN
PROGRESS:- r ' + S eLr Sc7q,
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SEPTIC TANK PUMPE SMASHED, FILLED WITNESSED YES ❑ NO
AS-BUILT:
INPUT DATE: t: 1 I d
W/2007 Town of South Windsor INPSECTION REPORT 07
APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR,CT-
FEE $60.00
_Location of proposed work: q Q S£PH 4�q Lot #
Street No. Street Name
Premises owned by: C'o 7z D
Name of Firm: Phone: �'60 g�r-23.3 2
Address of Firm: 0 Z3o yc 2 9 f 4-e 1 ,c1 C7V A/
TYPE OF WORK:
Lay House Drain ; Repair House Drain
Lay Main ; Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with c T(/C S (Z
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 ''` 414kl!�£lz- the holder of Drain
Layer's license No. 20 '2 7 z -<- Only holders of P-1,_U- or W-9 licenses
will be Jssued 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. '10/0
Sign Print Name: 17D r11'S 4),4L- EPA
tensed Drain Layer
Date: S- 3 r
Standard Forms\PM t WPUCATION FOR DRAIN LAYERS PERmrr.doc
TOWN OF SOUTH WINDSOR
SANITARY. SEWER LATERAL f FIELD LOCATION
DATE. OF CONSTRUCTION: ' }
BUILDING ADDRESS
STREET ;
SUBDIVISION:
NORTH ARROW
i
t N` 140M _ 34
2
._I_ ,._,_.�
CONTRACTOR (PRINT) NAME mr CONTRACT R'S SUPERVISOR (PRINT)
STREET ADDRE SIG NA E
6-a DATE
TOWN STATE ZIP INSPECTED BY TOWN
DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER