HomeMy WebLinkAboutDrain Layers Permits 942 Sullivan Avenue (2) 1300009 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 04/18/2013i
GIS ID: 87300942 FEE: 60.00
MUNIS APPLICATION# 201300459A 04 1-
� 3E EXPIRATION DATE: 05/18/2013
APPLICANT Vy ^L LOCATION
NAME: BUSINESS OWNER ADDRESS: 942 SULLIVAN AVENUE
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ADDRESS: SOUTH WINDSOR, CT 06074 � OWNER: MARTIN RONALD F&PAULE MARTIN
,- I I I WOOD POND RD
PHONE WEST HARTFORD,CT 06107
WORK DESCRIPTION: REPAIR SEWER LINE
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THE DRAIN LAYER ASSIGNED TO THIS PERMIT 14AS 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.
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ISSUED BY DATE INSPECTED INSPECTED BY
4/18/2013 11:31 AM
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: 130 000 9 CONTRACTOR: t.1Sf n
LOCATION: 9 q P, ,5;,,
TYPE OF WORK:_
DATE INSP NEEDED: DATE INSP:
INSPECTED BY:
WORK IN i � 9
PROGRESS:_ dtg1nl.1r - /ern 0,a xs5�1
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SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: L'I`"` DATE:
S/FORMS/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 pro ork: ?�iy 1,560)j / � �Lot#
Street No. Street Name
Premises owned by:
Name of Firm:.- e�'wxc-*'�e Phone: Sa -i (0
Address of Firm:_ //l We)d d'
TYPE OF WORK:
Lay House Drain ; Repair House Drain
y'o Lay Main----; Lay Lateral for Commerdal/Industrial St^Y? i;VP
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 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. f�w�c!. !!�1 � IFA SAiUITARYSEWER LATERAL
IS Wrmm 7S FEET OF WELL
IT MUST BEAIR TESTED
Signed: Print Name:
Licensed Drain Layer
Date: !)/-q //_3 .
Standard forms\Permits APPLICA�N-FOR DRAIN LAYERS PERMIT.doc
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TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: ��.�/t :_
BUILDING ADDRESS
STREET : &1 16 van A V E
SUBDIVISION:
NORTH ARROW
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CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPERVISOR (PRINT)
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STREET ADDRESS SIGNATURE
ATE
TOWN STATE ZIP INSPECTED BY TOWN
DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER
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