HomeMy WebLinkAboutDrain Layers Permits 70 Hazel Street 1400033 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 09/12/2014
GIS ID: 40800070 FEE: 60.00
MUNIS APPLICATION# 201401294 - EXPIRATION DATE: 10/12/2014
APPLICANT - = LOCATION
NAME: SKIPS SEPTIC = ADDR99-S: 70 HA EL STREET
ADDRESS: 6 NUTMEG DRIVE A! OWNER: ASS IN RONALD R&SHARON F
P O BOX 29 70 HAZEL STREET
ELLINGTON,CT 06023 = SOVJ =WINDSOR,CT 06074
PHONE 860 87 2332
WORK DESCRIPTION: NEW ShWI✓R t 4h El TION THE DRAIN LAYER ASSIGNED TO THISPI IVIIT-HAS A VALID LICENSE ISSUED BY TIDE/STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORTH`IN,THE ATTACHED`CONDITIONS'. ALL 1ORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDA1 ALL OSHA'REQUIREMENTS,AND THE ATTACHED CONDITIONS.
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ISSUED BY DATE INSPECTED INSPECTED BY
9/12/2014 9:10 AM
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: 11-1 600,3 3 CONTRACTOR:-
LOCATION: *j Qb
TYPE OF WORK: '� gal c.�7 st-� Cc� v�Y��c nh f, ire
DATE INSP NEEDED: DATE INSP: /G /
INSPECTED BY: 8b
WORK IN
PROGRESS: �/ b r 39 �iC....
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INPUT: i' DATE: 9/a//v
S/molloy/forms 2014 Town of South Windsor INPSECTION REPORT 14
APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
1540 SUU1VAN-AVENUE
PUBLIC WORKS DEPARTMENT
TOWN HALL
SOUTH WINDSOR, CT
FEE $60.00
Location of proposed work: 7® as 7,o / ne-e gl— Lot #
Street No. Street Name
Premises owned by: /ZN' R S T C 4- /n/
Name of Firm: Phone: goo- g'7 S-Z 33 z
Address of Firm:__ P- L ti 67o 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 S-D r. 3 3
Existing Water Supply: Public Water Well
Proposed Start Date S9PT Estimated time for completion
ALL WORK TO BE IN ACCORDANCE WrM.TOWN OF SOUTH WINDSOR STANDARDS,
ALL OSHA.REQUIREMENTS AND CONDITIONS ATTACHED TO THE PERMIT
Permit is to be issued to _rJ7" AjA1-&£X - the holder of Drain
Layer's License No. o a.o-7-1z 1 Only holders of P-1, P-7. or W-9 licenses
will be Issued a perm1L 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. 3d�� 360 2 so 3 PLEASE NOTE:
IFA SANITARYSEWER LATERAL
IS WITHIN75FELT OFA WELL
ITMUSTBEAIR TESTED
Signed: Print Name: 93 w9z��-rc-
Li ensed Drain Layer
Date:
standard Forms\Permits\APPLICAIION FOR DRAIN LAYERS PERMIT doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: I �
BUILDING ADDRESS
STREET : 1-I A21
SUBDIVISION:
NORTH ARROW
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CONTRACTOR (PRINT) NAME OF CONTRACTORS SUPERVISOR (PRINT)
(=� NUTN�b Dif q&l 1 9 t
STREET ADDRESS SIGNATURE
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TOWN STATE ZIP INSPECTED BY TOW
�60` )s a �� DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER