HomeMy WebLinkAboutDrain Layers Permits 59 Cliffwood Drive (3) 1200047 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 08/27/12 =
GIS ID:21000059 FEE: 60.00
MUNIS APPLICATION# 201201098 =„ EXPIRATION DATE: 09/26/12
APPLICANT" = LOCATION
NAME: SKIPS SEPTIC A ADDRESS' 9 C IVEWOOD DRIVE
ADDRESS: 6 NUTMEG DRIVEER GJDRIAN ALAN R&STEPHANIE K
P O BOX 29 = S9 c- WOOD DRIVE
ELLINGTON, CT 06029 % #�IJTH A`INDSOR,CT 06074
PHONE 860-875 �32 -
_�
WORK DESCRIPTION: NEW SE
THE DRAIN LAYER ASSIGNED TO THIS PERM11�iIT`HAS A VAIILi �I£`E,ISSU>I�`ByTHE STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORTH I TI t~=ATTAIDOII�iT1ON Al L GV�S�tK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDAIDS3A1 OSHA TTACHED CONDITIONS.
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ISSUED BY DATE INSP CTED INSPECTED BY
8/27/2012 12:43 PM
i
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: ® yy.
CONTRACTOR: �l�-/
LOCATION: C 1 4-c tod Qp( D r ') V e
TYPE OF WORK: )\Je 4i) Z e coe r e D kI yi,pe cam`i e n
DATE INSP NEEDED: DATE INSP: gf�9l>
INSPECTED BY: f3D
WORK IN
PROGRESS:r �r :' GP°' P��- ?S/®2 3� ��®n S1+.,,16
Tee '— Imo p�r2 5 dry 'J C�r -e
5�ejo/vac i�k- Pi,,w "j, FJ'c c
SEPTIC TANK PUMP E ; 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:
Street No. Street Name
"Premises owned by: - A44AJ s--E p 1jw V1 C_
SX(PS ->EPn�
. Name of.Firm.. Phone: 9(od -?75- 233�L
Address of Firm: k-rn-,F Gz '(� a 7-9 4'_ 41-(f1 ra nl
TYPE OF WORK:
Lay House Drain : Repair House Drain
Lay Main Lay Lateral for Commercial/Industrial
Building of—acres
Connection will be made with � ` sum 3.s— f C—
Existing Water Supply: Public Water Well
Proposed Start Date `� a�� z Estimated time for completion 6 29
ALL WORK TO BE IN ACCORDANCE WITH TOWN OF SOUTH WINDSOR STANDARDS,
ALL OSHA,REQUIREMENTS AND CONDMONS ATTACHED TO THE PERMIT
Permit is to be issued to -rbT the holder of Drain
Layer's License No. v zo -7?z s 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.
CBYD N0. PLEASE NOTE:
IFA SANITARYSEWER-LATERAL
IS W.TTHrN7S FEE T OF WELL
IT MUST BEAIR TESTED
SignedZ� Print Name:_ "7) 1?'S 41,4kZ(-,rX
censed Drain Layer
Date:
Standard Forms\Permits\APPLICA1-I0N FOR DRAIN LAYERS PERMIT.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: a�
BUILDING ADDRESS ��
STREET : C(-) F�FWocjn C)R ,
SUBDIVISION:
NORTH ARROW *3
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M ICRAE( LAW- � MH
CONTRACTOR (PRINT) NAME OF CO TRACTOR'S SUPERVISOR (PRINT)
G NVI NG Ott A�
STREET ADDRESS SIGNATURE
EU-INGTahl CT, OC�Oo��I g DATE
TOWN STATE ZIP INSPECTED BY TOWN
';(0 - S-7s- aC?L�Z DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER