HomeMy WebLinkAboutDrain Layers Permits 660 Nutmeg Road 1200012 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 04/03/12 ;
GIS ID: 65100660 =- FEE: 60.00
MUNIS APPLICATION# 201200329 EXPIRATION DATE: 05/03/12
APPLICANT ;, - =;, LOCATION
NAME: BUSINESS OWNER
ADDRESS,, 664I�1UTMEG ROAD
ADDRESS: SOUTH WINDSOR,CT 4647 OWNER. GUYPHI LLC
PO`Bfl k356
;
SOUTH VINDSOR,CT 06074
PHONE
WORK DESCRIPTION: ABANDONING OIL AND E ASE=SPA. TOR
THE DRAIN LAYER ASSIGNED TO THIS PERMIT HAS A`�ALII I ICI NSI ISUED:B Y THE STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORTH IN FHA ATTACHI3I}`6O�INTIONS AIaL WQRK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDARDS,ALL OSHA REt t3I EMENFS,- THE ATTACHED CONDITIONS.
ISSUED BY ATE INSPEC D INSPECTED BY
4/3/2012 12:31 PM
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: - /� 060/, OONTRACroR: }�t
LOCATION: e A
.TYPE OF WORK: Y\\ 0 1 � � �
'DATE INSP NEEDEti: DATE INSP:
INSPECFED BY: ey .
WORK IN
PROGRESS:_ A,� � � �.,dd
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SEPTIC TANK PUMPED,SMASHED, FILLED WITNESSED Q YES ❑ NO
INPUT: C DATE: >0
W12007 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 work: &66 goo n N �- Lot #
proposed
Street No. Street Name
Premises owned by:
Name of Firm: Ad Phone:
Address of Firm: 4o 10
TYPE OF WORK: - /
Lay House Drain: Repair House Drain
Lay Main Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with
Existing Water Supply: Public Water Well
Proposed Start Date Y 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 t ������ 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.
PLEASE NOTE:
CBYD No. IFA SANITARYSEWER LATERAL
IS WITHIN75 FEE T OF WELL
IT MUST BEAIR TESTED
Signed: Print Name: Lmv
Licensed-Ur-a—in—Layer
Date: ,/ 3 11A
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS :
STREETu}/nc G nd Nyrt
SUBDIVISION:
NORTH ARROW
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CONTRACTOR (PRINT) 11 NAME OF NT OR'S VIS (PRINT
Nv�tnt �t(
STREET ADDRESS SIGNATURE
DATE
0 0`7`-E
TOWN STATE ZIP INSPECTED BY TOWN
$Go' s � �� DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER