HomeMy WebLinkAboutDrain Layers Permits 79 Benedict Drive (2) 1400049 TOWN OF SOUTH WINDSOR, CT
PENT NUMBER DRAIN LAYER PERMIT
DATE: 12/17/2014
GIS ID: 09600079 FEE: 60.00
MUNIS APPLICATION# 201401797 EXPIRATION DATE: 01/16/2015
APPLICANT LOCATION
NAME: SOLVIT ADDRESS 79 BENEDICT DRIVE
ADDRESS: 65 FARMINGTION VALLEY DRIVE OWNER: HORNISH ROBERT R&JOAN K
PLAINVILLE, CT 06062 79 BENEDICT DRIVE
SOUTH WINDSOR, CT 06074
PHONE 860-747-2000
WORK DESCRIPTION: REPAIR HOUSE DRAIN
THE DRAIN LAYER ASSIGNED TO THIS PERMIT HAS A VALID LICENSE ISSUED BY THE STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORTH IN THE ATTACHED`CONDITIONS'. ALL WORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDARDS,ALL OSHA REQUIREMENTS,AND THE ATTACHED CONDITIONS.
C 6,10 1 10 _ .
ISSUED BY DATE INSPECTED INSPECTED BY
12/17/2014 3:56 PM
--------------
----------- -----
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.j YowCONTRACTOR: y
LOCATION: ��E'�l G I"
TYPE OF WORK: r'P0 .I P
DATE INSP.NEEDED: DATE INSP: i
INSPECTED BY: 'i-mil__
WORK IN
PROGRESS:_ /_ mac ,>- rr -ram( P� ' � . .®► ,
G'v ►trJ i —E � ��rvc t`p 1it �C V&j Vf L��iii ��L✓i 9 mac,
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: C DATE:
S/molloy/forms 2014 Town of South Windsor INPSEMON REPORT 14
. t
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:— � t3en��l,'��- Dr —Lot#
Street No. Street Name
*Premises owned by:-.-- R6 b H6 r n(3ti .
Name of Firm:_ Sd) y.I'7" Phone: T60, 7y L-2000
Address of Firm: 65 P/a,4t p/l/e L
TYPE OF WORK.•
Lay House Drain __; Repair.House Drain
Lay Main ; Lay Lateral for Commerclai/Industrial
Building of ages s
Connection will be made with _AerkC.
Existing Water Supply: Public Water__ Well
Proposed Start Date t _9 Estimated time for completion 124,511y
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 f+ T 9 i/c r- ea v the holder of Drain
Layer's License No. -P/-. Only holders of P-1, P-7. or W 9 licenses
will be issued a permit. PERMIT WILL E KPIRE 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. _20 iy 5oDo _5'3 4 TFA SANITARYSEWER-LATERAL
IS WITHIN75FEET OFA WELL
lT MUST BEAIRT�ESTED
Signed: Print Name:
Licensed Drain Layer
Dater 9 11y .
Standard FOrmsTermits\APPLICATION FOR DRAIN LAYERS PERMrT.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: r - 18 - � 1 Y
BUILDING ADDRESS : 71
STREET : n& °fir-,
SUBDIVISION:
NORTH ARROW
!
I i
i t
To - __• t t
�._._ +._
I ,
.�-"'- , •-�----- ..�._.._. ..r i .�..._..._i ._i... ._tom.-_ _-
I
--
i I i <
, I I )
1
t A- i _.__ i I I --
"--..,' ! - i- -'_. I t�`� v i-_ I --�--___�--_
es
CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPS SOR (PRINT)
STREET ADDRESS ' SIGNATURE
� I'
N INSPECTED � / DATE
TOW STAT�� ZIP INSPECT �� /��i
U BY TOWN
"76 DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER