HomeMy WebLinkAboutDrain Layers Permits 100 Clinton Drive (2) 1400021 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER _ DRAIN LAYER PERMIT
DATE: 07/07/2014 r
GIS ID:21300100
FEE: 60.00
MUNIS APPLICATION# 201400876 EXPIRATION DATE: 08/06/2014
APPLICA LOCATION
NAME: SKIPS SEPTIC ; D C TON DRIVE
ADDRESS: 6 NUTMEG DRIVE s ItD THOMAS J&LUCHIANNA M
P O BOX 29 CL TON DRIVE
ELLINGTON CT 0 f
y INDSOR,CT 06074
PHONE 860-87 - 2 . j
WORK DESCRIPTION: NEWS C
N �
THE DRAIN LAYER ASSIGNED TO THI - rLIA&S A - SS- STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FO IF s ORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDL3A „-IIvI ATTACHED CONDITIONS.
ISSUED BY DATE INSP CTED INSPECTED BY
7/7/2014 8:38 AM
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: CONTRACTOR: I .� P
F
LOCATION: C k f710dl L)--f; V-42
TYPE OF WORK: De u'7 n Y er 44i /
DATE INSP NEEDED: DATE INSP: :7/lZ Ll
INSPECTED BY: RD
WORK IN
PROGRESS: (0 k (Q P itc, S b TZ 3S FraN
clew 1-ail a�..�( sat: —.rc"���•Q-c
SEPTIC TANK PUMPED, SMASHED, FILLED t/ WITNESSED D-Y8 ❑ NO
AS-BUILT:
INPUT:_ DATE:
S/2014 Town of South Windsor INPSECTION REPORT 14
APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $60.00
Location of proposed work: /aV C4- 1-N-,TAl PJ'Z- Lot #
Street No. Street Name
Premises owned by: -r07-A —M-Z>
Name of Firm: 1117 61/7-7s/C Phone:
Address of Firm: N u— Z�lZ iA)G-77r AJ
TYPE OF WORK:
Lay House Drain ; Repair House Drain ;
Lay Main ; Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with PVC ST�rc 3 5�
Existing Water Supply: Public Water Well
Proposed Start Date 4e<< «+« 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 -7*Atk the holder of Drain
Layer's License No. e 2 o '7 7 z �— 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. o2o ,1¢ Z 6o / 747
Signed-. Print Name: 7M741.off Gill-
Licensed Drain Layer
Date: 6 2 7- l �—
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: 7 1-711
BUILDING ADDRESS : ZOO
STREET : I:>r e,
SUBDIVISION:
NORTH ARRO
10
Az
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W Se
CONT CTOR (PRINT) NAME OF CONTRACTOR'S SUPERVISOR (PRINT)
STREET ADDRESS SIGNATURE
Ili�K 4,o•j G} ? DATE
TOWN STATE ZIP INSPECTED BY TOWN
DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER