HomeMy WebLinkAboutDrain Layers Permits 230 Graham Road 1300004 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER
-- DRAIN LAYER PERMIT
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DATE: 02/06/2013
GIS ID: 37500230
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EXPIRATION DATE: 03/08/2013
APPLICANT Jaw
LOCATION
NAME: SKIPS SEPTIC = A DRES 2-30`GRAHAM ROAD
ADDRESS: 6 NUTMEG DRIVE = = OER SWIE�LCKI BRIAN C
P O BOX 29 - i GANDLEWOOD DR
ELLINGTON, CT 0602SrInk-
PHONE - SOUTH WINDSOR,CT 06074
860-875 2332
WORK DESCRIPTION: NEW SEWL OA
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THE DRAIN LAYER ASSIGNED TO THIS PERMfT HAS A VAS L E1 I ISSUEDSY-T'E STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORTIIN THIS AT I AIII } IT1pNS� ALL WORK SHALL BE IN ACCORDANCE WITH
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THE TOWN OF SOUTH WINDSOR STANDARD ALI OSHA�IIJREW--NTS,A*THE ATTACHED CONDITIONS.
ISSUED BY 2/6/2013 2:34 PM DATE INSPECTED INSPECTED BY
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: 1 (7 p(3 l
�I CONTRACTOR: k1�PS
LOCATION:-
TYPE OF WORK: fit°
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DATE INSP NEEDED: DATE INSP: � -lY-43
INSPECTED BY: 8
WORK IN
PROGRESS:_ O z ftcAv Pv°c s
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SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: DATE; �r]q- C
S/FORMS/TOWN OF SOUTH WINDSOR INSPECTION
APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $60.00
Location of proposed work: Lot #
Street No. Street Name
Premises owned by: t r a►n 5toi e+L ►c k
Name of Firm: Phone: 860-- Yl t- 233 2
Address of Firm: N �`- '' G iZ ? o COY-' 29 — ( �'V Goo f'j
TYPE OF WORK:
Lay House Drain ; Repair House Drain ;
Lay Main ; Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with 7Yc Sam 3 5-
Existing Water Supply: Public Water Well
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Proposed Start Date -:t 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 -I&IA wqk X--F 7z- the holder of Drain
Layer's License No. dzO -7,7z-:�- . 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. c2oi3 0600 930 .
Signed: Print Name:
*Ui4ensedain Layer
Date: - 3
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
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BUILDING ADDRESS
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SUBDIVISION: N /A
NORTH ARROW
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CONTRACTOR (PRINT) NAME OF CONTRACT R'S SUPE L( T)
STREET ADDRESS SIGNA URE
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TOWN 1 STATE ZIP INSPECTED BY TOWN
Zoo DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER