HomeMy WebLinkAboutDrain Layers Permits 21 Farmstead Drive (2) 1100031 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 08/18/11 „= -
GIS ID: 31800021 - FEE: 60.00
MUNIS APPLICATION# 201100932 = EXPIRATION DATE: 09/17/11
APPLICANT LOCATION
NAME: SKIPS SEPTIC Af J ` ADDRESS;, 21.FARMSTEAD DRIVE
ADDRESS: 6 NUTMEG DRIVE OWNER; BELODY WILLIAM J&AGNES M
P O BOX 29 21 1 ARMTEAD DRIVE
ELLINGTON,CT 06019, UTI- INDSOR,CT 06074
PHONE 860-8751332 -
WORK DESCRIPTION: NEW SEWEI-CONI�ICTIOt
THE DRAIN LAYER ASSIGNED TO THIS PERMIT HAS A UALII)i ICENSE SSUED'BY TINE STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORT ,IN THE ATTACHtD`CONtftIONS'. ALL WORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDARbS,ALL OSfw REQUIREMENTS,AND THE=ATTACHED CONDITIONS.
ISSUED BY ATE INSPECTED INSPECTED BY
8/18/2011 3:30 PM
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: 0100_51 TO15
CONTRACR: i .S
LOCATION: r—
TYPE OF WORK:_. Se L"')e CC) w1 r 0 Yl
DATE INSP NEEDED: DATE INSP: S/2 3 �i
INSPECTED BY: b )
WORK IN
. PROGRESS: Goh-Tra � s3R�C �- t���.L�d � � �� .3,r- ifrv�n 54kb
+p Ffc.ti1 a h-,�,+�e r >n LA 4 d&A rv-Cle-, �lay� Ga.�.,a e�-�i�a
Cwd 2 ro e.,e S�.�f� - �a, 34 eer,-sLek S4-&_,-c=
i° s a d c:eJ:e . TA-PEZ
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES NO
AS-BUILT: ✓
INPUT: DATE:
W/2007 Town of South Windsor INPSEMON REPORT 07
APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Location of proposed work: l le-5RTz/h s rr/�b Lot #
Street No. Street Name
Premises owned by: /L c /4711 RE 1-4-O.)Y
Name of Firm: SF c Phone: 73'- 23 3 2-
Address of Firm: l�- 0. 6Qx 7-9 A)
TYPE OF WORK:
Lay House Drain yC ; Repair House Drain
Lay Main ; Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with � VC SD 3
Existing Water Supply: Public Water Well
Proposed Start Date Wk Of $ Zz 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 _rUA the holder of Drain
Layer's License No. zo -7'7 2- Only holders of P1 orP-Z.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. o, 0 �
Signed: Print Name: '
icensed Drain Layer
Date: `�' �' /(
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc.
TOWN OF SOUTH ANDSOR
SANITARY-- SEWER LATERAL. FIELD LOCATION
DATE OF CONSTRUCTION: `� �' ° ))
�: Fo,rm_ eS-4yacc h�iV�c;
BUILDING ADDRESS : .
STREET -: _ i S'T 4T 'hro vim,
SUBDIVISION:
NORTH ARROW
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CONTRACTOR (PRINT) NAME dF RA OR'S SUPE (P )
co Vito
STREET ADDRESSDATE
SIGNA E ��
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TOWN STATE ZIP INSPECTED BY TOWN
DATE
TELEPHONE DUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING .ENGINEER / DEVELOPER