HomeMy WebLinkAboutDrain Layers Permits 180 Smith Street (2) 1100026 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 07/25/11
GIS ID: 83700180 = FEE: 60.00
MUNIS APPLICATION# 201100 5 EXPIRATION DATE: 08/24/11
APPLICANT_" = = , .. LOCATION
NAME: KF REALTY LLC ADJURES 180" MIH STREET
ADDRESS: 972 PLEASANT VALLEY16AD 43WNER. I-F P P-ERTIES LLC
SOUTH WINDSOR,GT OF,074 - 475 WHEELER RD
"
OUTRW IND
PHONESOR,CT 06074
WORK DESCRIPTION: NEW SEWER`CONICTION" "
THE DRAIN LAYER ASSIGNED TO THIS I�ERI I4T I�IAS A V2.L-lD-LICENS ISSUED BY TIDE STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORTH IN THE ATTACHED-`CONDITIONS': ALL-WORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDARDS,AI I OSHA REQUIREMENTS,AND THE ATTACHED CONDITIONS.
°7 . d -
ISSUED BY DATE INSPECTED INSPECTED BY
7/25/2011 10:49 AM
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: 00 (0 CONTRACTOR: /
LOCATION:
TYPE OF WORK:- Lt�41 �'( YI ✓1
DATE INSP NEEDED: DATE INSP:
INSPECTED BY: 4 D
WORK IN
PROGRESS: ( L' PVC She 351 rrga4 !to
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: DATE:
W/2007 Town of South Windsor INPSECTION REPORT 07
�IO�Da <e
APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
1540 SULLIVAN AVENUE
PUBLIC WORKS DEPARTMENT
TOWN HALL
SOUTH WIN'DSOR, CT
FEE $60.00
.Location of proposed work: l.PU Em$ �''`� �� Lot #
Street No. Street Name
Premises owned
y Name of Firm: eic l.rr
C)V-)ArUC4ibV Phone:
Address of Firm: 175—
TYPE OF WORK:
Lay House Drain V ; Repair House Drain ;
Lay Main ; Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with g b Do
Fisting Water Supply: Public Water Well
Proposed Start 0ate_� 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 A-11,411) � the holder of Drain
Layer's License No. ti LWl.QZ . 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 aft rd thereto. Applicant has received
Town Streetccavation Permit No. //''((//��//1 ' and/or ConnDOT Permit No.
PLEASE NOTE:
CBYD No. IFA SANITARYSEWER LATERAL
IS WITHIN 75 FEET OFA WELL
IT mvsrBEAIR TESTED
Signed:--.,zz Print Name:
Licensed Drain Layer
Date: '7—el— /l
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc
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