HomeMy WebLinkAboutDrain Layers Permit 167 Carriage Drive (2) 1500033 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 06/16/2015
GIS ID: 17100167
MUNIS APPLICATION# 201500728 FEE: 60.00
EXPIRATION DATE: 07/16/2015
APPLICANT, LOCATION
NAME: EASTERN WATERPROOFING ADDRESS: 167:CARRIAGE DRIVE
ADDRESS: P 0 BOX 504 OWNER: LABONTE MARK&TAMMY LYNN
SOUTH WINDSOR, CT"74 167;CART IAGE DRIVE
SaUTH WINDSOR, CT 06074
PHONE 860-875 664-6
WORK DESCRIPTION: NEW SEWER CONNECTION
THI D`RAIIV I AYEI AS NED TO THIS 1�'I;RMIT HAS A VALID LICENSE ISSUED BY THI STATE AND HEREBY AGREES-MALL-
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 REQUIREMENTSS AND THE1-T-T-AC-HED CONAi-T-TONS
14 r.S
ISSUED BY DATE INSPECTED INSPECTED BY
6/16/2015 9:05 AM
TOWN OF SOUTH WINDSOR INSPECTION REPORT
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LOCATION: % ( ---
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TYPE OF WORK: 612PC a211 n�'
DATE INSP NEEDED: DATE INSP:�r
INSPECTED BY: Q
WORK IN
PROGRESS: Cn�� �-c�� �Asi � � `' P✓� S 2 3 Frew.
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SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED E YES ❑ NO
AS-BUILT:
INPUT: L DATE: P
S/molloy/forms 2014 Town of South Windsor INPSECTION REPORT 14
APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
1540 SULLIVAN-AVENUE or 5V
PUBLIC WORKS DEPARTMENT
TOWN HALL '
SOUTH WINDSOR,CT
FEE$60.00
-Location of proposed work:jLo dhc-�'Lc c _Lot#
Street No. Street Name
Premises owned br—, -W2 — LA- f4 i e
Name of Rrrs,• tAS*0. --� ns -
4 s� � • ✓--
r Address Of Firm. N-I AAA
TYPE OF WORK:
Lay House Drain Repair House Drain
Lay Main_; Lay Lateral for Commerdal/Indusbial r
Building of acres
Connection will be made with o lvi(2 3�
Existing Water Supply: Pu lic Water_ Well
Proposed Start Date 2 ( Estimated time for completion
ALL WORK TO BE IN A RDANCE Will-!.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. 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 Penult No.
and/or ConnDOT Permit No.
PLEASE NOTE:
CBYD No. i S �3ot a rFA SANITARYSkWER-LATERAL
IS WITHIN75FEET OFA WELL
ITMUSTBEAIR TESTED
Signed• Print Name:
� • c
Licensed Drain Layer
F.
Date:
Standard Forms\PermbXAPPLICATION FOR DRAIN LAYERS PERMIT.&C
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: (y /l 9 1ao
BUILDING ADDRESS /67
STREET : C 4 9rgXA,�79 -bfQTVn
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CONTRACTOR (PRINT) NAME OF PRINT)
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TOWN STATE / ZIP INSPECTED BY TOWN
DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER;/ DEVELOPER