HomeMy WebLinkAboutDrain Layers Permits 488 Sullivan Avenue 1200002 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 01/09/12
GIS ID: 87300488 - FEE: 60.00
MUMS APPLICATION# 201200017 - EXPIRATION DATE: 02/08/12
APPLICANT -- - LOCATION
NAME: ENVIRONMENTAL SERVICtS ADDRESS:: 4WSULLIVAN AVENUE
ADDRESS: 90 BROOKFEILD STIELF pWAIE LUCK FIVE LLC
SOUTH WINDSOR,OT06-074 = 125 ISV IN ROAD
SOUTH WINDSOR,CT 06074
PHONE 860-528-5-0 -
WORK DESCRIPTION: DISCOMTEO SEAR = ==
THE DRAIN LAYER ASSIGNED TO THIS RERMITI3AS A VAL3D L1CI 1;I 1ISSUEI1-$Y H STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORTS IN PI3E ATTACHED9NDITONS' 'Al.---WOORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDARDS,ALA OSHA REQUIREIVIEN ,AMID THE ATTACHED CONDITIONS.
ISSUED BY DATE INSPECTED INSPECTED BY
1/9/2012 1 I:02 AM
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT No.* - CONTRACi'OR: �i 111 �121dZ - a ICE
LOCATION: t
TYPE OF WORK:- ) C� n r1i S C
DATE INSP NEEDED; DATE INSP:�
INSPECTED BY:_ ran
WORK IN
PROGRESS
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
1540 SULLIVAN AVENUE
PUBLIC WORKS DEPARTMENT
TOWN HALL
SOUTH WINDSOR, CT
FEE $60.00
-Location of proposed work: ��� cs Uy�� Lot #
Street No. Street Name Y'
Premises owned by: G I'z t Ue- L (_ C
Name of Firm: 4 'V S C e 1111EC Phone:� J�
Address of Firm:___
TYPE OF WORK:
Lay House Drain ; Repair House Drain ;
Lay Main ; Lay Lateral for Com ercial/Industrial
Building of acres ���Cd n n eG Sew t
Connection will be made with
Existing Water Supply: Public Water Well
Proposed Start Date - .2--• 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 LnV1<ny4wYoipA 1 SAv%&-y the holder of Drain
Layer's License No. 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.
�O ,� ���.� PLEASE NOTE:
CBYD No. �- IFA SANITARYSEWER LATERAL
IS WITHIN 75 FEET OFA WELL
IT MUST BEAIR TESTED
Signed: (��Print Name: '
License ain Layer
Date:
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: U
BUILDING ADDRESS : SCIv `J t1f/
STREET : �I� I ✓E
SUBDIVISION:
INORTHROW
lvv
v ,1. _
--- — = 1 - A
f
G�yfaOA)m (-)Ulll� � U�4 jMicNACI Co U -ILLS G .
CONTRACTOR (PRINT) NAME-OF CONT TOR'S SUPERVISOR (PRINT)
3reivs�l� s+
STREET ADDRESS SIGNA RE
U) h. 1 DATE
TOWN STATE ZIP INSPECTED BY TOWN
R66 5�L;�E 9 Soo DATE
TELEPHONE NUMBER
WHITE -`TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER j DEVELOPER