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HomeMy WebLinkAboutDrain Layers Permits 15 Pepin Place (2) 1400047 TOWN OF SOUTH WINDSOR, CT PERMIT NUMBER DRAIN LAYER PERMIT DATE: 12/05/2014 GIS ID: 70700015 = FEE: 60.00 MUNIS APPLICATION# 201401745 EXPIRATION DATE: 01/04/2015 APPLICANT `' LOCATION NAME: ATLANTIC EXCAVA`�ON INJC ADDRES y 1 I PIS PLACE ADDRESS: 363 PARUM ROAD 'C IEI f T M B ILDING CO INC COLCHESTER,CT 064I � tIID6K STREET �ZI FNCTON,CT 06790 PHONE WORK DESCRIPTION: NEW SEWEbNGTlO la- Raw , THE DRAIN LAYER ASSIGNED TO THIS 1 RMM IIA A SiALID LI ENSE IS UEI3 Y T IE I ATE AND HEREBY AGREES TO ALL THE TERMS AND CONDITIONS SET FORTIIN THE'ATTAIED`CgNI�TTI}NS; AID W4:RK SHALL BE IN ACCORDANCE WITH THE TOWN OF SOUTH WINDSOR STANDAINS AZT OSHA REQZ--- W_' NT- AI TH ATTACHED CONDITIONS. ll� ISSUED BY DATE INSPECTED INSPECTED BY 12/5/2014 1:16 PM ------ - - - -------------- TOWN OF SOUTH WINDSOR INSPECTION REPORT PERMIT NO.: CONTRACTOR: AtZW116 Gri,"4, 12�_'�Oyg LOCATION: TYPE OF WORK: �D �.¢� 66'o V'e DATE INSP NEEDED: DATE INSP: r INSPECTED BY: it WORK IN PROGRESS: C<v_4, -6_ eh ' ' �`�= i✓�n 614—.-,ll LV" NCH qe wife / � n 41 PC SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO AS-BUILT: INPUT: t - 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: / /"PVX Lot# 2 Street No. Stfeet Name Premises owned by: CC2 . Name of Firm: 7� �c c le•�t Phone: Address of Firm: lc . � . �r C 7, TYPE OF WORK: Lay House Drain Repair House Drain : Lay Main ; Lay Lateral for Commerdal/Industriai Building of acres Connection will be made withC S � 279 3,5- Bdstlng Water Supply: Public Water Well Proposed Start Date Estimated time for completion �� ALL WORK TO BE IN ACCORDANCE WITH.TOWN OF SOUTH WINDSOR STANDARDS, ALL OSHA_REQUIREMENTS AND CQNDPIONS ACHED TO THE PERMIT Permit is to be issued to the holder of Drain Layer's License No. g . Only holders of P-1, P-7. or W 9 licenses will be issued a permit. PERMIT WILL EKPIRE 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. /� © /y6' 7, TFA SANITARYSMER-LATERAL IS WITf rN75FEET OFA WELL IT MUST 5EAIR TESTED Sign : - 5 Print Name: /raZZ cr Licensed Drain1jaVer Date: Standard Forms\Permits\APPLICAIION FOR DRAIN LAYERS PERMrT.doc TOWN OF SOUTH WINDSOR SANITARY SEWER LATERAL FIELD LOCATION DATE OF CONSTRUCTION: Aw// ,Z/ BUILDING ADDRESS zoo AI STREET : `A /gzc lv SUBDIVISION: NORTH ARROW ,r.. � 1 I { cl r Jv 7Jg�. i 40, i ; I i CONTRACTOR (PRINT) y NAME OF CONTRACT R'S SU SO (PRINT) STREET ADDR S SIGN E / DATE e TOWN STATE ZIP INSPECTED BY TOWN y 7 4 DATE TELEPHONE NUMBER WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER