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HomeMy WebLinkAboutDrain Layers Permits 74 Lawrence Road (2) 1500003 PERMIT NUMBER TOWN OF SOUTH WINDSOR, CT DATE: 01/05/2015 DRAIN LAYER PERMIT GIS ID: 52800074 MUNIS APPLICATION# 201500006 FEE: 60.00 EXPIRATION DATE: 02/04/2015 APPLICANT" NAME: ENVIRONMENTAL S1.RVICHS INC LOCATION ADDRESS: 90 BROOKFIELD STREBT ADDRESS;_` 74 Lq ENCE ROAD SOUTH WINDSOR, OT9bp74 OWATER CCgRCOIAN CAROL BROWN 74 PHONE LIWRENCE ROAD 860-528 9500 - SOUTI IINDSOR, CT 06074 WORK DESCRIPTION: NEW SEWER G©NECTION TVIIIO NSWIN&DOINAO GPWORK THE DRAIN LAYER ASSIGNED TO THIS AERItL1 HAS A VALID LICENSE ISSUED BY T14E.STATE AND HE THE TERMS AND CONDITIONS SET FORTH.INTI E ATTACHED CONDITIONS : ALL WQ {SHALL D IN THE TOWN OF SOUTH WINDSOR STANDARFQS ALL OSHA REQUIIZEIVIENTS AN} 1 HE'ATTACHED BE IN AGREES TO ALL ACCORDANCE WITH CONDITIONS. ISSUED BY 1/5/2015 8:16 AM DATE INSPECTED r INSPECTED BY --------------- TOWN OF SOUTH WINDSOR INSPECTION REPORT PERMIT NO.: CONTRACTOR: LUZ .(2f'I LOCATION: TYPE OF WORK: �D YI pezc ®f> DATE INSP.NEEDED: DATE INSP:_t i5 INSPECTED BY: ab WORK IN PROGRESS: P vc- Sbp 3 , 6•0.-�, �•TC/lJb �3 P�A,`� "��Q/�.�. eo�t �c.�r�.h� i :3/tl f'✓�3�trf lot / C J /�f��'_ � '✓71 SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED 2�ES ❑ NO AS-BUILT: - INPUT:_ __ DATE: S/molloy/forms 2014 Town of South Windsor INPSEMON REPORT 14 APPLICATION FOR DRAIN LAYER PERMIT TOWN OF SOUTH WINDSOR 1540 SUL .IVAN AVENUE PUBLIC WORKS DEPARTMENT TOWN HALL SOUTH WINDSOR,CT FEE $60.00 .Location of proposed work:- 7 y a W r ox a Lot# Street No. Street Name "Premises owned by: Name of Firm:_P S - K:- — V=\ C . Phone:g60- 8 9.3- 1196 Address of Firm.--_i b 3 ��v.vj " o c�c9 n c C-T 0 606) TYPE OF WORK: Lay House Drainer Repair House Drain Lay Main : Lay Lateral for Commendal/Industrial Building of aces Connection will be made with _ -v, C Existing Water Supply: Public Water_ Well Proposed Start Date f of 11' s Estimated time for completion 1 3 v I S 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 the holder of Drain Layer's License No. a O 8 P a 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. 90 y- a° _63 g S IFA SANITARYS�WER LATERAL IS WITHIN75FEET OFA WELL IT MUST BEAIR TESTED Signed: Print Name: -Zt o Licensed Drain Layer Date:- a `i o- 1 Standard FormsTermitsXAPPLICATION FOR DRAIN LAYERS PERMIT.doc TOWN OF SOUTH WINDSOR SANITARY SEWER LATERAL FIELD LOCATION k DATE OF CONSTRUCTION: BUILDING ADDRESS 7,1/ STREET _ L-a c /Z&4b 7 SUBDIVISION: NORTH ARROW I _ __ ..._. �.__ ....-._. -ter;•--_- __. _ { J._ i t M i - - _ CONTRACTOR,(PRINT NAME OF CONTRACTOR'S SUPERVISOR (PRINT) STREET ADDR S SIGNATURE QATE TOWN STATE ZIP INSPECTED BY TOWN DATE TELE HP 0 E NUMBER ✓ WHITE - TOWN PINK - CONTRACTOR VCI I A111 ruin UWN OF SOUTH WINDSOR SANITARY SEWED LATERAL FIELDfLOCATION DATE OF: CONSTRUCTION: �. BUILDING ADDRESS 7`'l.. L rnc�c R I STREET SUBDIVISION: MM AM 31,C f 1 /1 IVTRACTOR (PRINT) ............................. v NAME OF CONTRAC R S PERVISQR PRINT 'REET ADDRESS s'' llY SIGNATURE 9 OZ9 MATE iWN STATE ZIP INSPECTED BY TOWN DATE Ug'fME NUMBER fHITE - TOWN PINK - CONTRACTOR XEU.QW - CONSULTING ENGINEER / flEVF!nprR