HomeMy WebLinkAboutDrain Layers Permits 673 Griffin Road (2) 1300046 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 12/09/2013
GIS ID: 39000673 FEE: 60.00
MUNIS APPLICATION# 201301799
EXPIRATION DATE: 01/08/2014
APPLICANT LOCATION
NAME: SKIPS SEPTIC ADDRESS: 673GIIFFIN ROAD
ADDRESS: 6 NUTMEG DRIVE CS"ER REG&U RICHARD R&MARY R
P O BOX 29 671�R FFIN ROAD
ELLINGTON,CT 06 2 „ $OUTH UVINDSOR,CT 06074
PHONE 860-87�Z332= -
WORK DESCRIPTION: NEW SW-9R LAIEIALQNCI30L�1
THE DRAIN LAYER ASSIGNED TO THI E1LI
PERMIT HAS A VRLICENSE-4SSUSI[)=BY THI STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORTS 11 Tf1E ATTACHED CONDITIONS;:[ALL WORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDARDS-- AL OSHA REQUIREMENTS ANIITHL ATTACHED CONDITIONS.
ISSUED BY DATE INSPECTED INSPECTED BY
12/9/2013 12:09 PM
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APPLICATION FOR DRAIN LAYER PERMIT
a0130/71 TOWN OF SOUTH WINDSOR
p
�1 1540 SULLIVAN AVENUE
PUBLIC WORKS DEPARTMENT
TOWN HALL
SOUTH WINDSOR,CT
FEE$60.00
Location of proposed work: IC?3 6(Z rF`iAl 1Z Lot#
Street No. Street Name
-Premises owned by .72-r-,/`y .] Ph£G 6
Name of Firm: <S`�i s SC-?7-ic Phone: 7 Z 33 2
Address of Firm: Al"-7ri, £C �� (� 0 /,3vc 2-`l l-4- ,J G7a A/
TYPE OF WORK:
Lay House Drain- Repair House Drain
Lay Main ..__; Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with � /�VC S2�/L- 3
Existing Water Supply: Public Water X Well
Proposed Start Date rak a f /= z Estimated time for completion 2 P/L s
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. 107 017 z Only holders of P-1, P-7 or W-9 licenses
will be issued a permit HERMIT WILL EKPIRE 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. - o l3 ¢70 Zt z r IFA SANITARYSFWER-LATERAL
IS WITffIN75FEET OF WELL
IT MUST BEA,IR TESTED
Signed: Print-Name: � �ffS wl�lc f/L
4Lic nsed Drain LLayer
Date: 7-
Standard FOrmsTermits\APPLICATION FOR DRAIN LAYERS PERMIT.doC