HomeMy WebLinkAboutDrain Layers Permits 10 Governors highwa 1300037 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 10/18/2013
GIS ID:36900010 FEE: 60.00
MUNIS APPLICATION# 201301542 - EXPIRATION DATE: 11/17/2013
APPLICANT LOCATION
NAME: J&H SLATER CONST tO" &ofAISDIES-:, IQ GOVERNORS HIGHWAY
ADDRESS: 75 COMMERCE WAY � ""= C WNER :ETIENN) DANIEL P
SOUTH WINDSOR,CT 06674 40131ZIfITMAN CIRCLE
SQUTH VWINDSOR,CT 06074
PHONE 860-528-5232.=
wood,
WORK DESCRIPTION: NEW SEWE CQN i CTT(N&I-A eOT LGI 10)1 FEL t S PAID IN 1974
THE DRAIN LAYER ASSIGNED TO THIS I'ERMT-f IAS A"V"AbJDJ..IG_1�S ISSUED-ICY THE STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORTh,IfUHE-ATTACJ4 D CONKI T IONS ". L VVQ K SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDARDS ALL OSHA F-00t Iv1ENfiS,AI�JI).THE:ATTACHED CONDITIONS.
ISSUED BY DATE INSPECTED INSPECTED BY
10/18/2013 3:47 PM
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: 0 CONTRACTOR: C4- S 1.,F
LOCATION: c'
TYPE OF WORK:— Pt,c �
DATE INSP NEEDED: DATE INSP:
INSPECTED BY: 6 >
WORK IN
PROGRESS: J H love- sDrz 3! f=�o s-ru6
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SEPTIC TAN KqEUM ,<5TH FILLED WITNESSED ❑ YES VNO
AS-BUILT:
INPUT: DATE:
W12007 Town of South Windsor INPSECTION REPORT 07
APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDS
OR
1540 SUU IVAN AVENUE
PUBLIC WORKS DEPARTMENT
TOWN HALL
SOUTH WINDSOR,Cr
FEE$60.00
:Location of proposed work: tQ Lot#
Street No. Street Name
-Premises owned by:��t��t �
- Name of Firm '' selt Phone: <�-U
Address of Firm: -7 S- CAi)m jokLe- w 1-
TYPE OF WORK
Lay House Drain Repair House Drain
Lay Main_ ( y teral for CvmmerdaVIndustriai
Building of acres
Connection will be made with -S.P�
Existing Water Supply: Public Water Well
Proposed Start Date l0 'z 1 Estimated time for completion 1
ALL WORK TO BE IN ACCORDANCE WITH_TOWNOF SOUTH WINDSOR STANDARDS,
ALL OSHA-REQUIREMENTS AND CONDITIONS ATTACHED TO THE PERMIT
Permit is to be issued to 0 n the holder of Drain
Layer's License No. ZOCv 1 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. -�o G 97=9,,7 PLEASE NOTE;
IFA SAIVITARYSEWER LATERAL
IS WITHIN75 FEE T OF WELL
IT MUST BEAIR TESTED
Signed
Print Name: w9An
Licensed D a yer
Date: .
Standard`FormsTermiWAPPLICATION FOR DRAIN LAYERS PERMIT.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: I�� 13
BUILDING ADDRESS AlWwk .I
STREET
SUBDIVISION:
NORTH ARROW
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CONTRACTOR (PRINT) NAME OF CONTRACTORS SUPERVISOR (PRINT)
15 c"mm G., 0
STREET ADDRESS `c '� SIGNATU
SDIS vJ�t�B�(lj '� ®�'1 / DATE
TOWN STATE ZIP INSPECTED BY TOWN
COO 0-X6.51K2- DATE
TELEPHONE NUMBER
WHITE — TOWN PINK — CONTRACTOR YELLOW — CONSULTING ENGINEER / DEVELOPER