HomeMy WebLinkAboutDrain Layers Permits 201 Scantic Meadow (3) 1300043 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 11/20/2013
GIS ID: 81000201 FEE: 60.00
MUNIS APPLICATION# 201301726 EXPIRATION DATE: 12/20/2013
APPLICANT, - - LOCATION
NAME: HOMEOWNER ADDRESS; I SC ANTIC MEADOW ROAD
ADDRESS: SOUTH WINDSOR, CT Q� 74 t3WEI FRREITA LOUISE E
201 CAITIC MEADOW
SOUTH WINDSOR,CT 06074
PHONE
WORK DESCRIPTION: RELOCATE ROW00- OE TINE AN TARY EWRRLATERAL
DUE TO CP1LICTVPI IL�IW HOUSEIfiN
THE DRAIN LAYER ASSIGNED TO THIS I' RMIT 1 AS A-V-ALII�LLCENSE I3SUEI3-BY THE fiATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORTS MHE"ATTACHED` ONITIONS',ALL WC31tK SHALL BE IN ACCORDANCE WITH
I�
THE TOWN OF SOUTH WINDSOR STANDAS K`LL OSHA RE{ UIRE1lfIEN1SsAN�?THE ATTACHED CONDITIONS.
ISSUED BY DATE INSPECTED INSPECTED BY
11/20/2013 10:59 AM
i
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: 1'30bo�/ CONTRACTOR: J-)DhreztoVerL
LOCATION: o?b! 4Sr�,-�y i e M�� �r�� r .
TYPE OF WORK: �� pnitic��� �,�iir ;nu �.r�• SPe� IuJADe <e�flict c�i -1�-
DATE INSP NEEDED: DATE INSP: .
INSPECTED BY:
WORK IN
PROGRESS: I 12PA- Y'e fze_'L vq �.L,
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: DATE:
W/2007 Town of South Windsor INPSECTION REPORT 07
AeIn rii— �(SO 1-716
130op 43 .
APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
1540 SULLIVAN AVENUE
PUBLIC WORKS DEPARTMENT ,
TOWN HALL
SOUTH WINDSOR,CT
FEE$6000
.Location of proposed work:-2r)l Sca Pn gin, YZ lot
Street No. Street Name
Premises owned by: o`QPV
G�6 vz r3 Name of Finn; uvrwn►f 2 2.- 5 5 5 2
_ Phone:
Address of Firm:
TYPE OF WORK: ,Move sewe+C 1�ne WD \A t��< o- v,ouse to sjdjQ
Lay House Drain_______; Repair:House Drain
Lay Main Lay Lateral for Commercial/Industrial
Building of aces
Connection will be made with 6 Pvc,
Existing Water Supply: Public Water ✓ Weil
Pro sed 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 Ra�Y fi S m ikj—home h mr►ey- the holder of Drain
Layer's Ucense 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. IFA SANITARYSEWER.LATERAL
IS WITHIN75 FEET OF WEIL
r-rMUSTBEAIR TESTED
Signed.
Print Name:'
- c'`a�. -
LU se rain Layer
Date:
Standard rflrmsTermitAAPPUCATION FOR DRAIN LAYERS pERMIT.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS : 2-M
STREET : cAnl - OAea<Z } V aA
+ SUBDIVISION:
NORTH ARROW
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CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPERVISOR (PRINT)
STREET ADDRESS GNATURE/`
4L "��
fn� \/Q i nasI C GT 0 oca4 DATE
TOWN STATE ZIP INSPECTED BY TOWN
[ \ 12-5rp32, DATE
TELEPH NE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER