HomeMy WebLinkAboutDrain Layers Permits 29 Brookfield Stree 1200011 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 04/02/12
GIS ID: 14700029 '= = FEE: 60.00
MUNIS APPLICATION# 201200323 = EXPIRATION DATE: 05/02/12
APPLICANT = = LOCATION
NAME: SKIPS SEPTIC - 7ADDRESS.. 29 BRObKFIELD STREET
ADDRESS: 6 NUTMEG DRIVE DOI L&JENNIFER D
P O BOX 29 29 ;I RO( FIELD ST
ELLINGTON, CT 06029 = SOUTH WINDSOR,CT 06074
PHONE 860-875 �
WORK DESCRIPTION: NEW SEWED-CONNEC-TION
22
THE DRAIN LAYER ASSIGNED TO THIS P-ERMIT HAS A Vt ID LI-EK E ISSUED BY 7 HE S TAT AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORTh- T3II `ATTAGHEI3`CtINffi IONS AI L WORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDARDS AL1 OSHA REQUIREMENCS,AND THI<ATTACHED CONDITIONS.
ISSUED BY DATE INSPECTED INSPECTED BY
4/2/2012 10:54 AM
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMTf NO.. - 1111 OONTRAcrop,
LOCATION: cI)9
.TYPE OF WORK_
DATE INSP NEEDED: DATE INSP:
INSPECTED
WORK IN
PROGRESS:_ k,Ps z ill d 6 12 c sb 3rro SY21�
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SEPTIC TANK PUMPED,SMASHED, FILLED i,-" WITNESSED OYES ❑ NO
'AS-BUILT:
INPUT: C DATE: q h/
W12007 Town of South Windsor mpsemm REPORT 07
APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS AEPAIft(` I"N
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, Cr
FEE $25.00
Location of proposed work: �9 d° kF f Lot #
Street No. Street Name
Premises owned by: j 9,-JA1(F C X J I M
Name of Firm: SITS S'F P17c— Phone: ?(00-87S- 2 33Q_
Address of Firm: f.0 . 3" 2 � - (F k L ttJG-r-a nl
TYPE OF WORK:
Lay House Drain Y Repair House Drain ;
Lay Main ; Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with 52)71- 3 r IYC
Existing Water Supply: Public Water Well X
Proposed Start Date �" 3 - !Z Estimated time for completion 4 - 1Z
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 -TT '' GJ1q1-keX- the holder of Drain
Layer's license No. 0 zQ 717 2S . Only holders of P1 or P7 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. '2 o
LSign Print Name: Al 1#fiA7'1f5 Gi!/iL1c /Z.ul- .
Lic sed Drain Layer
Date: 3-30 '/2
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: 3 `t t
BUILDING ADDRESS �1
STREETS
—f— SUBDIVISION:
NORTH ARROW 196 A 9
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CONTRACTOR (PRINT) NAME OF C NTRACT RCS SUPERVISOR (PRINT)
STREET ADDRESS SIGNATURE
,F-�u N(S, o w c-r b66 19 DATE
TOWN STATE ZIP INSPECTED BY TOWN
(�(clo ` c6l c�li 3-a DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER