HomeMy WebLinkAboutDrain Layers Permits 673 Ellington Road 1200063 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 12/14/2012
GIS ID: 30300673 FEE: 0.00
MUNIS APPLICATION# 201201675 EXPIRATION DATE: 01/13/2013
APPLICANT' LOCATION
NAME: GERBER CONSTRUCTION CO ADDRESS: 61 'ELLINGTON ROAD
ADDRESS: 1 NUTMEG DRIVE QWNER: ST>,FRANCIS OF ASSISI CHURCH CORP
ELLINGTON,CT 06029k'.' 67 ; ELLINGTON ROAD
SOUTH'WINDSOR,CT 06074
PHONE 860-875 66M4
WORK DESCRIPTION: REPAIR SANITARY SEWER LATERAL
SAINT FRANCIS'OF ASSISI CHURCH
THE DRAIN LAYER ASSIGNED TO THIS PERMIT HAS A VALID LICENSE ISSUED BY THE STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORTH IN TEE ATTACHED` ONAITIONS.' AT L.WORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDARDS�ALL.OSHA RE�iIREMEI�ITS,AII�THE ATTACHED CONDITIONS.
ISSUED BY DATE INSPECTED INSPECTED BY
12/14/2012 11:51 AM
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.:/ca� �'.� CONTRACTOR: ( y J 2
LOCATION: & 1 0 !l Ito r-\
TYPE OF WORK:
DATE INSP NEEDED: DATE INSP:
INSPECTED BY: �
WORK IN
PROGRESS:
�,� � ' ✓r/C s�rL �s� ���1 i�� e��ems.
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
____�mz
INPUT: Cam ` DATE:
SJFORMS/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: V)C S,1,AJ a UA6:mot 0AQ Lot #
Street No. Street Name
Premises owned by: A r
Name of Firm:_ r b?-/- % C Phone: S16--g
Address of Firm:_
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,
ALL OSHA.REQUIREMENTS AND CONDITIONS ATTACHED TO THE PERMIT
Permit is to be issued to y- 4,- �yiC, the holder of Drain
La er' -
y s License No. 7��y.� _ . Only holders of P-1, P-7 or W 9 Incenses
will be issued a permit. PERMIT WILL EXPIRE THIRTY(30) DAYS AFTER
BATE.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
"T'own Street Excavation Permit No. and/or ConnDOT Permit No.
PLEASE NOTE:
CBYD No. _ /.Z S�(>o%/�� IFA SANITARYSEWER LATERAL
IS Wrmm75FEET OFA WELL
IT MUST BE R TESTED
Signed:_
Print Name:
Licensed Drain Layer
Date: /� /3
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: _ a Ll -- 1A
BUILDING ADDRESS
STREET
SUBDIVISION:
NORTH ARROW
4,
--�-- --I.23
,- --� 4- 4-- --
�
i O i
��be-� Coe.
CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPERVISOR (PRINT)
STREET ADDRESS SIGNATURE
jr/4:��
TOWN STATE ZIP INSPECTED BY TOWN
DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER