HomeMy WebLinkAboutDrain Layers Permits 400 Evergreen Wa 1300001 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 01/11/2013
GIS ID: 31300400 FEE: 60.00
10 2013
APPLICANT LOCATION
NAME: FOLSOM CONSTRUCTION LLC ADDRESS: 400 EVERGREEN WAY
ADDRESS: 138 RYE STREET OWNER: EVERGREEN WALK LIFESTYLE CENTER
SOUTH WINDSOR, CT 06074 2650 THOUSAND OAKS#3150
MEMPHIS,TN 3 8118
PHONE 860-528-8928
WORK DESCRIPTION: INSTALL 2 GREASE TRAPS FOR-BONE FISH GRILL
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 THE ATTACHED`CONDITIONS'. ALL WORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDARDS,ALL OSHA REQUIREMENTS,AND THE ATTACHED CONDITIONS.
ISSUED BY DATE INSPECTED INSPECTED BY
1/1 1/2013 1 1:20 AM
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: 13 Obo o 1 CONTRACTOR: /' Co ►)',
LOCATION: L b o
TYPE OF WORK: 1 QS-A-a 1 k
DATE INSP NEEDED: DATE INSP: - // IS
INSPECTED BY:— f3 1�
WORK IN
PROGRESS:
Fo
Gr�Sl,ed
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT: f z
INPUT: C,A-� -. DATE:_
S/FORMS/TOWN OF SOUTH WINDSOR INSPECTION
APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
1540 SULLIVAN AVENUE
VU13LIC WORKS DEPARTMENT
TOWN HALL
SOUTH WINDSOR, CT
FEE $60.00
E
.Location of proposed work. ePMRftP W 6�
Street No. Street Name
Premises owned by:
Name of Firm: r o ti S t P u j to ti LLC Phone: 6 c) S 2-
Address of Firm: 13 V-t-W LA) iA)-SO C T o6clic
TYPE OF WORK: (I uS ALL_ Z C-4- C 1�C-45 E rP_4Vs)
Lay House Drain_; Repair f lou ;
Lay Main ; Lay Lateral for Commerdal/Industrial
Building of acres
Connection will be made with v L-
Existing Water Supply: Public Water Well
Proposed Start Date2 (3 Estimated time for completion I`-11 C 3
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 LL_0` 0 F0 11�114 the holder of Drain
Layer's License No, f'L Ni , 07084( -47 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 Pe...... ..— and/or ConnDOT Permit No.
PLEASE NOTE:
CBYD No. ��� �t0 w"l IFA SANITARYSEWER LATERAL
IS WITHrN75 FEET OF WELL
lT M11ST BEAIR TESTED
s J
Signed: Print Name: LSO ,<h fbL-�
Lic nsed Drain Layer
Date:_ i �c c 13
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATETr 11 r CONSTRUCTION"
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BUILDING ADDRESS �(o 160 (eev-1
STREET
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SUBDIVISION: �V tv, iq
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CONTRACTOR (PRINT) NAME 7LCTOR' SUPERVISOR (PRINT)
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STREET ADDRES§ SIGNATURE —� 1 ��
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TOWN STATE ZIP INSPECTED BY T®WN
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TELEPHONE NUMBER
WHITE — TOWN PINK — CONTRACTOR YELLOW — CONSULTING ENGINEER / DEVELOPER
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