HomeMy WebLinkAboutDrain Layers Permit 095 Carriage Drive (2) 1400034 TOWN OF SOUTH WINDSOR, CT
PENT NUMBER DRAIN LAYER PERMIT
DATE: 09/17/2014
GIS ID: 17100095 FEE: 60.00
MUNIS APPLICATION# 201401308 EXPIRATION DATE: 10/17/2014
APPLICANT = = LOCATION
NAME: JAMES THROWE D1A ADDRESS: - 95 CARRIAGE DRIVE
ADDRESS: 97 RIVERSIDE DRI F GWNER STENGEL DARLENE J
VERNON ROCKVI U&C`I'96066 ; 95'CA RfUAGEDRIVE
SOLIIi WINDSOR,CT 06074
PHONE 860-28 0095
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WORK DESCRIPTION: NEW St. "eONNECTION
THE DRAIN LAYER ASSIGNED TO THI ,-PF- IT HAS"A VALID LICENSE ISSUED_BY THE STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORTITIN"THE-ATTACHED CONDITI,ONS;, ALL WORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDAIS,ALL OSHA REQUIREMENTS,AND THE ATTACHED CONDITIONS.
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ISSUED BY DATE MPECTED INSPECTED BY
9/17/2014 9:18 AM
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: QQ,1? CONTRACTOR: da n-S
LOCATION: Is- ca f r 1 Co c, e �1 _
TYPE OF WORK: Ae Lj Se w.-e", C0 0 r ec*101-N
DATE INSP NEEDED: DATE INSP: lS /
INSPECTED BY:
WORK IN
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SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED eYES [] NO
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INPUT: DATE:
S/molloy/forms 2014 Town of South Windsor INPSECTION REPORT 14
APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
1540 SULLIVAN-AVENUE
PUBLIC WORKS DEPARTMENT
TOWN HALL
SOUTH WINDSOR,CT
FEE$60.00
Location of proposed work: �S rr, ' Lot#
Street No. StreefName
Premises owned by.-__/�gPL4-L
Name of Firm: � Phone:
Address of Firm: P)WO-5) V r✓»G
TYPE OF WORK:
Lay House Draln.--�', Repair House Drain
Lay Main_; Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with Sk�
Existing Water Supply: Public Water_ Well
Proposed Start Date y Estimated time for completion u
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
the holder of Dram
Layer's License No. . Only holders of P-1, P-7 or W-9 licenses
will be issued a permIL 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:
IFA SANITARYSkWER.LATERAL
IS WrTHIN7S FEE T OFA WELL
1T MUS7`BEAIR TESTED
Signed: Print Name:._am�c� ^r --�
Licensed Drain Layer -
Date: /fg /7
Standard r-OMIAP&MRAAPPLICAMN FOR DRAIN LAYERS PERMIT.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: 1116-
BUILDING ADDRESS
STREET
�I- SUBDIVISION:
NORTH ARROW
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CONTRACTOR (PRINT) l NAME qF CONTRACTOR'S S PERVISOR (PRINT)
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STREET ADDRESS SIGNA E
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TOWN STATE ZIP INSPECTED BY TOWN
< w (� Z/ DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER