HomeMy WebLinkAboutDrain Layers Permits 1209 Sullivan Avenu (2) 1100028 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 08/01/11
GIS ID: 87301209 - FEE: 60.00
MUNIS APPLICATION# 201100684 EXPIRATION DATE: 08/31/11
APPLICANT LOCATION
NAME: ENVIRONMENTAL SHRVICES INC ADDRESS_; 1209 SU�LIVAN AVENUE
ADDRESS: 90 BROOKFIELD STREET QTER MITCHELL JOHN J SR
SOUTH WINDSOR,CT 5074 1209 SUI LIVAN AVE
DUTH WINDSOR,CT 06074
PHONE 860-528-9500
WORK DESCRIPTION: NEW SEWEk CQNIECTI(
THE DRAIN LAYER ASSIGNED TO THIS kRMIT HAS A VALII?- ,jCI;N E ISSUED HY TI ESTATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORTH I&THE ATT-ACii aD`-CONDr'TIONS-' `ALL WORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDARDS;AFL OSHA REQiJIRE1�IENT ,AN kE'ATTACHED CONDITIONS.
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ISSUED BY DATE INSPECTED INSPECTED BY
8/1/2011 3:18 PM
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: / O CONTRACTOR: Gcf)0 i yD�VW tN ��S
LOCATION: d D QI 11 j y �
TYPE OF WORK:_ fvl"L-o
DATE INSP NEEDED: DATE INSP: i
INSPECTED BY:
WORK IN
PROGRESS: C�`' yc_ 3 Flo..-i
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SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED DYES ❑ NO
AS-BUILT:
INPUT: 'r v DATE: 3 I
W/2007 Town of South Windsor INPSECTION REPORT 07
APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
1540 SULLIVAN AVENUE
PUBLIC WORKS DEPARTMENT
TOWN HALL
SOUTH WINDSOR, CT
FEE $60.00
Location of proposed work: l c�0 S� j I ui.J w'� Lot #
Street No. Street Name
Premises owned by: i Pc a r �"V C I (-"o
Name of Firm: LANW RQ1 A JU+Al 9E2 01 C- t Avc Phone: R6050� g sda
Address of Firm: QO 12emkic-10 (, i
TYPE OF WORK:
Lay House Drain ; Repair House Drain ;
Lay Main ; Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with - 6
C
Existing Water Supply: Public Water ✓ Well
Proposed Start Date Estimated time for completion 3 l
ALL WORK TO BE IN ACCORDANCE WITH TOWN OF SOUTH WINDSOR ST NDARDS,
ALL OSHA REQUIREMENTS AND CONDITIONS ATTACHED TO THE PERMIT
Permit is to be issued to J4�c ��� '�aewsl - th older of Drain
Layer's License No. & Only hold rs of P-1, -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 ttached thereto. Applicant has received
Town Str Excavation Permit No. and/or ConnDOT Permit No.
PLEASE NOTE:
CBYD No. 1 l ' IFA SANITARYSEWER LATERAL
IS WITHIN 75 FEET OF WELL
IT MUST BEAIR T 5T D
Signed: Print Name: p d
ice ain Layer
Date:
standard For \Perini \APPLICATION FOR DRAIN LAYERS PERMIT.doc
TOWN OF SOUTH ANDSOR
SANITARY SEWER LATERAL 'FIELD LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS : "U
STREET • l � it /� �
SUBDIVISION: �1 � �`l.
NORTH ARROW
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CONTRACTOR (PRINT) NAME OF CONT .CTOR'S SUPE SOR (PRINT)
STREET ADDRESS SIGNATA
7c) wl,(V o C/-f U DATE
TOWN STATE ZIP INSPECTED BY TOWN
DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW- - CONSULTING .ENGINEER / DEVELOPER