HomeMy WebLinkAboutDrain Layers Permits 16 Brightman Circle (2) 1200058 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 11/14/12
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GIS ID: 13900016 A �' FEE: 60.00
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MUNIS APPLICATION# 201201530 ��� L�PIRATION DATE: 12/14/12
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APPLICANT?
LOCATION
NAME: J&H SLATER CONS CO y D .
I IITMAN CIRCLE
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ADDRESS: 75 COMMERCE WA V '
_� KE-LCO INC
SOUTH WINDSOR clT° 14 � 4 f L
y INGTON RD
PHONE 860-528-5252 = �01
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INDSOR,CT 06074
WORK DESCRIPTION: sff
APPLICANT AGREES TO FURNISH THE w
3ID REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANCMI IOJ2 +IAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THF111' T IS yV A ftk,ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OkC)iT yVI -
( IEIT MANUAL.
IS 1 ED B D ED INSPECTED BY
1 1/14/2012 1 1:43AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: 00,0, CONTRACTOR:S a'
LOCATION: IV h
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TYPE OF WORK: (V LOW
DATE INSP NEEDED: DATE INSP: 11
INSPECTED BY: !_3D
WORK IN
PROGRESS: !'_nH .+�c�a,� i s le `' p yc
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SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT:_ DATE: ,I
SjFORMS/TOWN OF SOUTH WINDSOR INSPECTION
APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
1540 SUU IVAN AVENUE
PUBLIC WORKS DEPARTMENT
TOWN HALL
SOUTH WINDSOR,CT
FEE $60.00
-Location of proposed work: � Lot#
—�:—
Street No. Street Name
-Premises owned by: -
Name of Firm: ') r� aAML Phone: g 515 Z
Address of Firm:l� Cfnm-61U WTI IWW a, CT
TYPE OF WORK:
Lay House Drain X 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 i 16 12 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. 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 WlTHrN75 FEE T OF WELL
IT MUST BEAIR TESTED
Signed: Print Name: lhot'j 5LA'M�
Licensed Drain Layer
Date: 1
8taroard FormsWermits\APPLICATION FOR DRAIN LAYERS PERMIT.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: k l �S 2
BUILDING ADDRESS
STREET
SUBDIVISION:
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CONTRACTOR (PRINT) NAME 61F CONTRACTOR'S SUPERVISOR (PRINT)
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STREET ADDRESS SIGNAT E
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TOWN STATE ZIP INSPECTED BY TOWN
DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER