HomeMy WebLinkAboutDrain Layers Permits 25 Pepin Place (2) 1400048 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 12/05/2014
GIS ID: 70700025 - = FEE: 60.00
MUNIS APPLICATION# 201401747 = EXPIRATION DATE: 01/04/2015
_ -
APPLICANT; LOCATION
NAME: ATLANTIC EXCAVATIQN 1110C AADRESSj 25 PIb PLACE
ADDRESS: 363 PARUM ROAD � �' T&M BUILDING CO INC
COLCHESTER,CT 0�41 _= = = Q OK STREET
VD-kIZIN ON,CT 06790
PHONE
7 if
WORK DESCRIPTION: NEW SEWE £ONt+IECTiC} '
THE DRAIN LAYER ASSIGNED TO THIS FRM�TIAS AAII�T.IEL�TESSUEI? �' MATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORTH IT THE ATTA FLED fJItI ITI(�N ALA,-WORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDA&S A OSHA REQUIREMENTS ANI�TII�ATTACHED CONDITIONS.
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ISSUED BY DATE INSPECTED INSPECTED BY
12/5/2014 1:52 PM
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: 7 CONTRACTOR: ���,
LOCATION:
TYPE OF WORK: 11 eLAJ
DATE INSP.NEEDED: DATE INSP:
INSPECTED BY:
WORK IN
PROGRESS: �'t -��� � ;�;� HI� � 1, "' f+�tr [� G t- lf•: �; t:,
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:__j
INPUT: DATE:
S/molloy/forms 2014 Town of South Windsor INPSEMON 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 Ace- Lot#
Street No. 86ietName
'Premises owned :by Y �
- Name of firm: z/ cpt Phone.
W(n
Address of Him: �.3 _ O %lS
TYPE OF WORK:
Lay House Drain_Repair House Drain
Lay Main ; Lay Lateral for Commerc ial/Industiial
Building of acres
Connection will be made with
Existing Water Supply. Public Water= Well
Proposed Start Date S i Estimated time for completion
4:
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_04_;1?Ak/-7�z the holder of Drain
Layer's License No. c o RZy�. P7. 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.
PLEASE NOTE:
CBYD No. -WUl/ Y O/ rFAA SANrTARYSVWERIATER4L
rS K/ITHrN75 FEE T OF WELL
1TM11S7'5EAIR TESTED
Sign Print Name: —.�a�l�J Ian
Licensed Drain Lake Y
Date:
Standard FOrms\Permits\APPUCATION FOR DRAIN tAYERs PERmmdoc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: Tr//
BUILDING ADDRESS
STREET w c
-I- SUBDIVISION:
NORTH ARROW
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CONTRACTOR (PRINT) NAME OF CONTRACTORS SU R (PRINT)
STREET ADDRESS
/ SI URE ,
�dl c�Ct�2 rc v.<r - � _ � i.z� I/f�DATE
TOWN ,g,S►TATE ZIP INSPECTED BY TOWN
<ilwo_ �� 7— �l�G DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER