HomeMy WebLinkAboutDrain Layers Permit 23 Balsam Fir Road 1300002 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 01/22/2013
GIS ID: 07150023
FEE - -60.00
_ -
TIS APPLICATION# 201300074 EXPIRATION DATE: 02/21/2013
APPLICANT- _ LOCATION
NAME: EAGLE EARTHWORK S_ERV ADDRESS 23 BALSAM FIR ROAD
ADDRESS: 101 N MOUNTAIN ROAD-i ��---MANNARINO BUILDERS INC
CANTON,CT 06019 4I}0 CHAPEL RD#3F
TTH WINDSOR, CT 06074
PHONE 860-693 2(�27
WORK DESCRIPTION: NEW SEWER C}NICTrt
THE DRAIN LAYER ASSIGNED TO THIS 1 ERI IIihIAS A VAI3 I I LA ISSUERS BYE HE-TATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FOR-hi iih- EAT FTEFS fONI 1TfOIJR' 'AI I WORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDARDS AI L OSHA RBiIRI�+IENS AII�THZ'ATTACHED CONDITIONS.
ISSUED BY DATE INSP CTED IN E E BY
1/22/2013 3:42 PM
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: l 30 o,:)_ CONTRACTOR: (S�c� le &a—*LQOX-h
LOCATION:_ a 3 tSc� � 12 r-�Jl
TYPE OF WORK:_ -e 63 Sea�&_t` Co ►lIn'c cbr
DATE INSP NEEDED: DATE INSP: - 3
INSPECTED BY: &>
WORK IN
ROE RESS: S d 2 3 S' ,, - - -----
L4S D�u aal e..� Q o, c tea,, ® J
P;r_t svrro-x 3 r.
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: C DATE:
S/FORMS/TOWN OF SOUTH WINDSOR INSPECTION
APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
1540 SULLIVAN-AVENUE
vua�� TTI'1L717
TOWN HALL
SOUTH WINDSOR,CT
FEE $60.00
:Location of proposed work: $&0 ,i F",-12b Lot #
,4�-
Street No. Street Name
'Premises owned by: Afnn r, h a
Name of Firm:.-� IL �r v �r1� C �1 Phone:� '207
Address of Firm: e 1 AloP114 A r/�
TYPE OF WORK:
Lay House Drain_; Repair House Drain
Lay Main Lay Lateral for Commerdal/Industrial
Building of acres
Connection will be made with
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 the holder of Drain
Layer's License No. .-78 l l,6 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 No. c�® 13 �20 � D ]1 PLEASE NOTE.:
IFA SANITARYSEWER-LATERAL
IS WITHIN75 FEE T OF WELL
Irmt1srBEAIR TESTED
Signed:-' � —A�r int Name: G�y e �-�� c9— —
Licensed Drain Layer
Date: 2-g-
standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc
TOWN OF SOUTH WINDSOR
SANITARY . SEWER LATERAL FIELD LOCATION
BUILDING ADDRESS ' "
STREET : Cx:I
SUBDIVISION:
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CON R (PRINT) NAME OF CONTRACTOR'S SUPERVISOR (PRINT)
STkEET ADDRESS rr SIGNATURE
3 / DATE
t0JWN STATE ZIP INSPECTED BY TOWN
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DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER j DEVELOPER