HomeMy WebLinkAboutdrain layer permit 96 Griffin Road 1000052 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 09/30/10
GIS ID: 39009999U Al
Niv FEE: 60.00
MUMS APPLICATION# 20100133 EXPIRATION DATE: 10/30/10
APPLICANT LOCATION
NAME: ENVIRONMENTAL SERVICES ADDRESS: 9999 GRIFFIN ROAD (96) "
ADDRESS: 90 BROOKFEILD STREET OWNER: TOWN-OF SOUTH WINDSOR
SOUTH WINDSOR,CT'6674 I540 SULLIVAN AVE
SOUTFI WINDSOR,CT 06074
PHONE 860-5284500"', .,
WORK DESCRIPTION: NEW SEWER CONNECTION HOUSE iN EAST WINDSOR HOOKED TO
SOUTH WINDSOR SEWERS
THE DRAIN LAYER ASSIGNED TO THIS PERMIT HAS,A VALID LICENSE ISSUED BY THE STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORTIS J,N THE.ATTACHED`CONDITIONS'. ALL,WORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDARI S,,'A-L OSHA REQUIREMENTS,AND,THE ATTACHED CONDITIONS.
ISSUED BY DATE INSPECTED INSPECTED BY
9/30/2010 10:16 AM
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: /Oo4W CONTRACTOR:
LOCATION: % fit^ i
TYPE OF WORK: cy
DATE INSP NEEDED: DATE INSP: Lo A,
INSPECTED BY: 13D
WORK IN
PROGRESS: . (9 ''�vc S 3Sri
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SEPTIC TANK PUMPED, SMASHED, FILLED l/ WITNESSED ❑ YES 0'NO
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INPUT: DATE: O /!�
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S/FORMS/TOWN OF SOUTH WINDSOR INSPECTION
APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
SC
FEE $60.00 NNE
t
Location of proposed work: /V PO Lot #
Street No. Street Name
Premises owned by: DC2,: + ) �J C,
Name of Firm: ALS r� � Phone:&0 5d=& 9500
Address of Firm: 9
TYPE OF WORK:
Lay House Drain, Repair House Drain ;
Lay Main : Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with
Existing Water Supply: Public Water l/r Well
Proposed Start Date U Lo
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
a
Permit is to be issued to_ 'i e-8)6(7,1 v �� 2�) thin holder of Drain
Layer's License No. Q q . Only holders of P-1, P-7 r W-9 licenses
will be issued a permit. PERMIT WILL EXPIRE THIRTY(30 AYS 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. do 10. 3') oo5v Y
Signed: Print Name: 1 c,l f
Lice rain Layer
Date: G 6
Standard Forms\ ermits\AP CATION FOR DRAIN LAYERS PERMIT.doc
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5 1540 SULLIVAN AVENUE SOUTH WINDSOR, CONN. 06074
AREA CODE 860/644-2511
OR Cot,
SEWER TEST REPORT
PROJECT:
LOCATION:
DATE: q 110
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OR STATION START STOP DROP START STOP TIME
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INSPECTED BY:
REMARKS: m/ �'�� �