HomeMy WebLinkAboutdrain layer permit 2674 Ellington Road 1000066 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 12/17/10 k
GIS ID: 30302674 '
y FEE: 60.00
MUNIS APPLICATION# 201001688 g EXPIRATION DATE: 01/16/11
APPLICAN LOCATION
NAME: SKIPS SEPTIC RE E INGTON ROAD
ADDRESS: 6 NUTMEG DRIVE
P O BOX 29 s VDWARD G
= z LINGTON ROAD
ELLINGTON,CT 06 SOR,CT 06074
PHONE 860-875 3
WORK DESCRIPTION: NEW SE I r
THE DRAIN LAYER ASSIGNED TO THIS ll-1 A Q yISU �TATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORT RK SHALL BE IN ACCORDANCE WITH
THE TOWN OR SOUTH WINDSOR STAND tI�4 Q ,A T ATTACHED CONDITIONS.
ISSUED BY DATE INSPECTED INSPECTED BY
12/17/2010:10:11 AMA
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: Ili CONTRACTOR: 5 PS
LOCATION: 7 -(Orj D GZr�
TYPE OF WORK:—I)euo iso yl
DATE INSP NEEDED: DATE INSP:
INSPECTED BY:131r->
WORK IN
PROGRESS: ( ✓r� �C� :3g,- Gmm S`fi�
-ro zalt o-p- hoL&A s. con +o q,"C,.df T20fj Wes.
F-c✓n co3��, •�� Cry sy.-� i�
lewd- T
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED EYES ❑ NO
AS-BUILT:_ t�-
INPUT: DATE: �a a
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
FEE $60.00
Location of proposed work: 2 6'7 4 Cl-L-114 ra J 7CD Lot #
Street No. Street Name
Premises owned by: t✓fi-rc7 S/4 CIE /Z'
Name of Firm: SV < �s �' -(-- -?7 C- Phone: 8'60 -C 4� r¢G
Address of Firm: eI u-rM f G b z - P G . 3 o x 2 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 P V C S I L 3
X
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 -TZ�" W i9LACE Z the holder of Drain
Layer's License No. OOZO '7?a ;- . 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. Z 0/6 S10 PTY
Signed: Vim' L �� Print Name.
Licensed Drain Layer
Date:
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc
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From: @CB m
Poste ay,
Convec �� ate Request -71 17 2
Poste 1540 SULLIVAN AVENUE • SOUTH WINDSOR, CT 06074
�OsoR c°�' TELEPHONE (860) 644-2511
Subject: Locate Request - 20105101732
(CALL BEFORE YOU DIG - CT) 12/16/2010 14:09:11
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-OT 4-SW SWINDS -T5
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*** REMOTE BATCH ENTRY ***
***** ROUTINE *****
TIME. .14:10 DATE. .12/16/2010
REQUEST NO. . .20105101732
LATITUDE. .41.8473945 LONGITUDE. .-72.5252380
TOWN. . . . . .SOUTH WINDSOR
ADDRESS. . .2674
STREET. . . .ELLINGTON RD
NEAREST
CROSS STREET. .MILLER RD
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TYPE OF WORK. . . . .HOOK TO CITY SEWER
AREA IS MARKED. . .YES
REMARKS:
NO ROAD CUT, MARK ENTIRE FRONT YARD
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START DATE. . . . . .12/21/2010 START TIME. .07:00
CALLER. . . . . . . . . .SUE MODZELEWSKI
CALL BACK. . . . . . .8-5
PHONE #. . . . . . . . .860-875-2332
FAX #. . . . . . . . . . .860-875-0428
ALT. PHONE #. . . .
EMAIL ADDRESS. . .SUE.SKIPS@SNET.NET
CONTRACTOR. . . . . .SKIP SEPTIC SERVICE
ADDRESS. . . . . . . . .6 NUTMEG DR
CITY. . . . . . . . . . . .ELLINGTON
STATE. . . . . . . . . . .CT
ZIP. . . . . . . . . . . . .06029
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EXCAVATOR DOING WORK. .TOM WALKER
ISSUED TO: DATE: TIME: BY:
DATE/TIME ARRIVED: TIME LEFT: COMPLETED BY:
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