HomeMy WebLinkAboutDrain Layers Permits 207 Lefoll Blvd (2) 1100038 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 09/26/11 "
GIS ID: 53100207 FEE: 60.00
MUNIS APPLICATION# 201101112 ;" EXPIRATION DATE: 10/26/11
APPLICANT- LOCATION
NAME: ROTO ROOTER ADDRE§ 207-LEILL BLVD
ADDRESS: 576 CHRISTIAN LANE OWI�IER dOODIA JOHN B &L1NDA A
BERLIN,CT 06037 -- = = 207-EF LL BLVD
OCJTH WINDSOR,CT 06074
PHONE 860-8831593 - -
WORK DESCRIPTION: EMERGE N SEWER REPAID
THE DRAIN LAYER ASSIGNED TO THIS ERMIT HAS A Y34LID Li EN E`ISSUEY7I Y THE TATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORTH TN THE ATTACHED`CONDITIONS'; Al L W9ItK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDARDS,AID OIIA REQUIRETCiIENTS,ANI1 THL7`ATTACHED CONDITIONS.
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ISSUED BY DATE INSPECTED INSPECTED BY
9/26/2011 11:00 AM
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: I 6003 CONTRACTOR: Ply e) -7b- 00
LOCATION: A Q I
-TYPE OF WORK: £n C
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DATE INSP NEEDED: DATE INSP: 9
INSPECTED BY: aD
WORK IN
PROGRESS: Co- c- .(T '. c-
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SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES LINO
AS-BUILT: e/
INPUT: DATE:
W12007 Town of South Windsor INPSEMON 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: 507 /.e �v1\ 6 1\1)0 Lot #
Street No. Street Name
Premises owned by: n ct �'�no i h
Name of Firm: Phone: 0 516-43S-0
Address of Firm:
TYPE OF WORK:
Lay House Drain ; Repair House Drain ;
Lay Main ; Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with 1 ernc o
Existing Water Supply: Public Water Well
Proposed Start Date3 ��- 1 ( , Estimated time for completion J- �l
ALL WORK TO BE IN ACCORDANCE WITH TOWN OF SOUTH WINDSOR STANDARDS,
ALL OSHA REQUIREMENTS AND CONDITIONS ATTACHED TO THE PERMIT )?40 93-15U
Permit is to be issued to Sco+Y Cnv&&k o4o-A.*l,rthe holder of Drain Soa}}
Layer's License No. ?'7 L&Ft Oniy 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. t and/or ConnDOT Permit No.
PLEASE NOTE:
CBYD No. c7 J)q a00056 IFA SANITARYSEWER LATERAL
IS WITHIN75 FEET OF WELL
IT MUST BEAIR TESTED
Signed:. 1004A6�t- Print Name: 5ca=lj ciuus-�
Licensed Drain Layer
Date: ;L f
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIr.doc
09/28/2011 PIED 6.156 FAX 8602290859 ROTO ROOTER - HARTFORD f�002/002
'OWN of SOUTH WIND•SOR
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SANITARY - SEWER LATERAL 'FIELD LOCATION
DATE OF CONSTRUCTION; ". �.�. .._ �.•
BUILDING ADDRESS
STREET Gly,o
SUBDIVISION;
4NORARR)OW
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CO RACTOR (PRINT) NAME OF CONTRAGJOR'S SUPERVISOR (PRINT)
STREET ADDRESS SIGNATURE
".6 , DATE
TOWN STATE ZIP INSPECTED BY TOWN
DATE
TILEPNONE NUMBER
WHITE - TOWN PINK -- CONTRACTOR YQ.LOW - CONSULTING .ENGINEER DEVELOPER