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HomeMy WebLinkAboutDrain Layers Permits 1236 Ellington Road 1300045 TOWN OF SOUTH WINDSOR, CT PERMIT NUMBER DRAIN LAYER PERMIT DATE: 12/09/2013 GIS ID: 30301236 FEE: 60.00 MUNIS APPLICATION# 201301798 = EXPIRATION DATE: 01/08/2014 APPLICANT LOCATION NAME: SKIPS SEPTIC = AMIjRES 123b ELLINGTON ROAD ADDRESS: 6 NUTMEG DRIVE = = £OWNER ,, CONAI DOMENICO S &MARIA R P O BOX 29 = 1 364EL11NGTON RD ELLINGTON,CT 062 �; S�LiTHVINDSOR,CT 06074 PHONE 860-875-23321 WORK DESCRIPTION: NEW SEWER I,ATEfAI COIr1NECTiON THE DRAIN LAYER ASSIGNED TO THIS1'EI MT T HAS A VALID LlttN-SE ISSUtIlD B`t 'THE-STATE AND HEREBY AGREES TO ALL THE TERMS AND CONDITIONS SET FORTH �7 THE ATTAIHED`CONDITI'ONS ALL GUORK SHALL BE IN ACCORDANCE WITH THE TOWN OF SOUTH WINDSOR STANDARDS HE AACHED CONDITIONS. D T ISSUED BY DATE INSPECTED INSPECTED BY 12/9/2013 11:58 AM TOWN OF SOUTH WINDSOR INSPECTION REPORT PERMIT NO.: CONTRACTOR: LOCATION: TYPE OF WORK:__ New DATE INSP NEEDED: DATE INSP: INSPECTED BY: Bl> WORK IN r, PROGRESS: 0 j���✓�"L ,SYJ I'© L.G7 T�L�•TJ t /1Gr7¢ G /n r� ..�4a� ril s<f-b, r�.�je�cs �� � a 1 "� Sal ��✓ S� - SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED Lg YES ❑ NO AS-BUILT: INPUT: G YVV DATE: W/2007 Town of South Windsor INPSECTION REPORT 07 Pcrw,' Lid /3 000 APPLICATION FOR DRAIN LAYER PERMIT a o l3 0/7 yg TOWN OF SOUTH WINDSOR 1540 SULLIVAN AVENUE PUBLIC WORKS DEPARTMENT TOWN HALL SOUTH WINDSOR,Cr FEE$60.00 Location of proposed work: l z3C_., Lot# ' Street No. Street Name Premises owned by: - Pd1� l 1 Co Co IV AC f Name of Firm: nG Phone: 86a B ? Z 3 3 Address of Firm: 6 N u- 6 )52 rQy, Z g z iN TYPE OF WORK: Lay House Drain__; Repair.House Drain Lay Maln Lay Lateral for Commerdai/Industrial Building of acres C. Connection will be made with c z a a 3 1- P VC- Existing,Water Supply. Public Water Well Proposed Start Date ulc /i7- z Estimated time for completion ALL WORK TO BE IN ACCORDANCE WITH TOWN OF SOUTH WINDSOR STANDARDS, ALL OSHA REQUIREMENTS AND CONDITIONS ATTACHED TO THE PERMIT Permit is to be issued to -1- W the holder of Drain Layer's License No. o z f Only holders of P-1, P-7 or W-9 licenses will be issued a permit PERMIT WILL EXPIRE THIRTY(30) DAYS AFTER DATE OF ISSUANCE. The undersigned Drain Layer hereby agrees to all the terms and conditions set forth in the Permit and attached thereto.. Applicant has received Town Street Excavation Permit No. and/or ConnDOT Permit No. CBYD No. -a 3 4-7o /3 2$ PLEASE NOTE: IFA SAWTARYSEWER-LATERAL IS W1 TfffN75 FEET OF WELL IT MUST BEAIR TESTED Signed: � Print Name: W -r*A& A1ML-kCE_7,L__ UceADrain yer Date: Z7 Standard FormsTermitsWPLICATION FOR GRAIN LAYERS PERMIT.doc TOWN OF SOUTH WINDSOR SANITARY. SEWER LATERAL FIELD LOCATION DATE OF CONSTRUCTION: /a ~ 90 BUILDING ADDRESS : a�3 4> STREET : C/11'wi SUBDIVISION: NORTH ARROW i I Li { ( F I I I I { __�-- 1 i f I � •„V\t ; I i � �M I i I I . " 6- �l 5M)A CONTRACTOR PRINT) NAME OF CONTRACTORS SUPERVISOR (PRINT) STREET ADDRESS SIGNATURE 1��vk c'.`t c \ O l ��\ TOWNS STATE ZIP INSPECTED BY TOWN COL S r� 3 Ja DATE TELEPHONE NUMBER WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER