HomeMy WebLinkAboutDrain Layers Permits 47 Benedict Drive (2) 1200055 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 10/24/12
GIS ID: 09600047 FEE: 60.00
MUNIS APPLICATION# 201201425 EXPIRATION DATE: 11/23/12
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APPLICANT
LOCATION
NAME: SKIPS SEPTIC � DRES 47 BENIDICT DRIVE
ADDRESS: 6 NUTMEG DRIVE ff _ 1 = TEI COLLIA ROBERT S&DORIS
PO BOX 29 �_
47BEIVIJDICT DRIVE
ELLINGTON,CT 06Q29� V INDSOR,CT 06074
PHONE 860-875 332 "
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WORK DESCRIPTION: REPAIR 00-U1?DAt _ %ii
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THE DRAIN LAYER ASSIGNED TO THIS F'ERM� HAS A uAI�L1SE ISSUEFD BYTLIE STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORTIS IId IW-B A TTACI D ON ITIOV ALL WORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDARD�AI L OSHA IW000NIEI�J�-AN F1 ATTACHED CONDITIONS.
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ISSUED BY DATE INSPECTED SPECTED BY
10/24/2012 8:37 AM
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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 &AI FD l r: 1 Lot#
Street No. Street Name
-Premises owned by: 72 63 r RT Co i-4-14 S9
Name of Firm: cSy/P 5' cSEP-nc- Phone: K 0 ?7 5'_z 3 3 2-
Address of firm: N 14-rMf c �� /'_ o• 6 ox .21 J'/_L/A/ (9_r�r1 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 ` T VC s3)t -3
Existing Water Supply: Public Water >/- Well
Proposed Start Date_�O z o Z 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 the holder of Drain
Layer's License No. l 2 7 z f 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. _ �o Z- �--,3 o0 Yz—. IFA SANITARYSEWER-LATERAL
IS WI7HIN7S FEET OFA WELL
/ IT MUST 8EAIR TESTED
Si ne . (.-- LI�Fr�
9 Print Name: l�A
Uc used Drain Layer
Date: /v — Z3 /�-
standard.Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIf.doc
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO,: / ovos-sue CONTRACTOR:
LOCATION:_ V >r
TYPE OF WORK: Gt
DATE INSP NEEDED: DATE INSP: !C � -rZ
INSPECTED BY: J5 P
WORK IN
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SEPTIC TANK PUMPED, SMASHED, FILLED N/A WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: C, VV\ ' DATE: /a---
S/FORMS/TOWN OF SOUTH WINDSOR INSPECTION
Skips Inc
PO Box 29
Ellington,CT 06029
ASBUILT SKETCH
Work Type: Septic System Repair Sewer Line Locate_Other
Address: 4k 1 bnP
Owner:2&Ltb�CmjltrtC_ Phone: 7gi4- %it Date:02-2- --1�
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