HomeMy WebLinkAboutDrain Layers Permits 124 Sullivan Avenue (2) 1200041 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 08/02/12 � s y y
GIS ID: 87300124 �� s
MUNIS APPLICATION# 201201011 FEE: 00
�e �� EXPIRATION DATE: 09/01/12
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LOCATION
NAME: O KEEFE EXCAVATIQ�T&EA_RTH�ORKS �_ �1DDRES f 4= T IVAN AVENUE
ADDRESS: 47 DELMAR ROAD g 111
SOUTH INDSOR TOWN OF 59
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GLASTONBURY,CT s � BY
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WORK DESCRIPTION: NEW SE* � I PROJECT NO FEE
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THE DRAIN LAYER ASSIGNED TO THIS s SAS A V sS'1�E�I '�IE1 ATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORTI 7N SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDAINS ATF�TTACHED CONDITIONS.
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ISSUED BY DATE INSPECTED INSPECTED BY
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: IRS
CONTRACTOR: LC e k
LOCATION: l 3 c /li V" Na,p
TYPE OF WORK:- &U) cSe p OhjpP�
DATE INSP NEEDED: DATE INSP: oo I1�
INSPECTED BY: (fin
WORK IN
PROGRESS: Ca ell' Sh2 S-f A—b
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SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT:_ �i DATE: qgq
S/FORMS/TOWN OF SOUTH WINDSOR INSPECTION
APPLICATION FOR DRAIN LAYER PERMrT
TOWN OF SOUTH WINDSOR �C)
1540 SULLIVAN AVENUE
PUBLIC WORKS DEPARTMENT 7VWn
F TOWN HALL
SOUTH WINDSOR, CT
FEE $60.00
.Location of proposed work:
Street No. Street Name
Premises owned by: �o
1
Name of Finn:: xrr� J � �f�� Phone._00 i�/ i 7 y
Address of Finn; L
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 Estimated time for completion.
ALL WORK TO BE IN ACCORDANCE WITH.TOWN OF SOUTH WINDSOR STANDARDS,
AI1.OSHA.REQUIREMENTS AND CONDITIONS ATTACHED TO THE PERMIT
Permit is to be issued to the holder of Drain
Layer's License No. Pla f �yy,P 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.
0/.2 ,3®C) 1770 PLEASE NOTE:
CBYD No. IFA SANITARYSEWER LATERAL
IS WITffIN 7S FEET OFA WELL
IT MUST SEAIR TESTED
Signed: Print Name: a.7i!J 44 Axoi l SO J�i(. toy
11ILice-nsedDrain Layer
Date: a / f:Z .
Standard FormsTermitsiAPPLICATION FOR DRAIN LAYERS PERMIT.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: 8�Z3
BUILDING ADDRESS 1 Z '
STREET : S u L-4- t v A 1-4 V .
SUBDIVISION:
NORTH ARROW
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CONTRACTOR (PRINT) NAME OF 0 CT 'S SUPERVISOR (PRINT)
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STREET ADDRESS �/ SIGNA RE ®�
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TOWN STATE ZIP INSPECTED BY TOWN
�AQ n R22`2 201 DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER