HomeMy WebLinkAboutDrain Layers Permits 761 Griffin Road 1200029 TOWN OF SOUTH WINDSOR, CT
PENT NUMBER DRAIN LAYER PERMIT
DATE: 06/26/12
GIS ID:39000761
FEE: 60.00
MUNIS APPLICATION# 201200843 y y EXPIRATION DATE: 07/26/12
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APPLICANT-1 X j y Y LOCATION��
NAME: HINCKLEY CONSTRUE7110I NC DRES 761 OR111IN ROAD
ADDRESS: 178 HIGHLAND VIEW shy 0ARIN HOMES LLC
SOMERS, CT 06071 A ,� T
E6ZOOK, CT 06016
PHONE A I �_ 5ILL-
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WORK DESCRIPTION: NEW SEWB&C � �� �
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THE DRAIN LAYER ASSIGNED TO THIS I RIWI WAS A flaI ' M ATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORT I Fi hON b.WORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STAND ARbSSH N r T�ATTACHED CONDITIONS.
ISSUED BY DATE INSPECTED INSPECTED BY
6/26/2012 11:33 AM
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: CONTRACTOR: nC
LOCATION: _ 7(a J c o TAT / /u
TYPE OF WORK: A)e-t,.j Se w-o� 4 h
DATE INSP NEEDED: DATE INSP: ��
INSPECTED BY: /bJ
WORK IN
PROGRESS: _Cd� ✓ in 1(P� (a^' C Cb YZ- 3 6' rro M s+wb
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SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: DATE:
S/FORMS/TOWN OF SOUTH WINDSOR INSPECTION
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: 7 L I Lot #
Street No. Street Name
Premises owned by: C,
Name of Firm:- \�°��. �-�..P t��. s Phone:9-G o 7 17S
Address of Firm: )-1
TYPE OF WORK:
Lay House Drain : Repair House Drain
Lay Main : Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with C. S OR 3!
Existing Water Supply: Public Water Well
Proposed Start Date�_� Estimated time for completion Q M 2.
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 to the holder of Drain
Layer's License No. L m,oasts 3'h Pj 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 WITHIN75FEET OFA WELL
IT MUST BEAIR TESTED
Signed: Print Name: C%yu n�1
Licens Dram Layer /
Date: LIB i!�- /ao) Q
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc
TOWN OF SOUTH : WINDSOR
SANITARY. - SEWER LATERAL FIELD LOCATION
DATE. OF, CONSTRUCTION: __ f ZaQ lam`
BUILDING ADDRESS :7G 1
STREET : r P"'),
SUBDIVISION: & too•c'��c� S �b d v�s ,n
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CONTRACTOR (PRINT) NAME OF tON RACTOR'S SUPERVISOR (PRINT)
STREET ADDRESS w SIGNATUR
® �+ DATE
TOWN STATE ZIP INSPECTED BY TOWN
16 DATE
TELEPHONE NUMBER'
WHITE - 'TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER