HomeMy WebLinkAboutDrain Layers Permits 154 Clinton Drive (2) 1500027 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 06/09/2015
GIS ID: 21300154 - FEE: 60.00
MUNIS APPLICATION# 201500679 EXPIRATION DATE: 07/09/2015
APPLICANT ;,LOCATION
NAME: SKIPS WASTEWATER ADDRESS-' 154 WNTON DRIVE
ADDRESS: 21 COURTNEY DRIVE - OWNER: - G-ALLIGA0I GAVIN&
ELLINGTON, CT 06029 154 CLTIVION DRIVE
SOUTH WNDSOR,CT 06074
PHONE 860-875-2332-
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WORK DESCRIPTION: NEW SEWER GONNECTIOIW "
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 FORTAJT THE_ATTACHED`CONDITIONS'.,ALL WORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDARDS,ALL OSHA REQUIREMENTS,AND,—
ATTACHED CONDITIONS.
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ISSUED BY DATE INSPECTED INSPECTED BY
6/9/2015 9:05 AM
TOWN OF SOUTH WINDSOR INSPECTION REPORT
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PERMIT NO:: �'S�'Q�� °�7 CONTRACTOR:
LOCATION: C j 3'0'7'0/1 V—
TYPE OF WORK 1'P- ,LA -�_P L0,04_ . 0 n YI)OC!I6n
DATE INSP NEEDED: DATE INSP:
INSPECTED BY: 6
WORK IN
PROGRESS: &0cc 5+0-v-4 t 6- '' F u.c- S D M '35
i' A S hid
14
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SEPTIC TANK PUMPED, SMASHED, FILLED ,/ WITNESSED YES ❑ NO
AS-BUILT:
INPUT: DATE:
S/molloy/forms 2014 Town of South Windsor INPSECTION 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: /j�4 CL�N�N �� Lot#
Street No. Street Name
*Premises owned by: /V 1COL r= C!l o /IA iC
- -- Name-of I3rm: - Sh:n(Ps -- r lfsT 4 - - ,
Phone. - -
V6o-87S, Z.
- Address of Rrm: Ca R TN F .Arz
TYPE OF WORK:
x . Lay House Drain--.:� ; Repair House Drain •
Lay Main._______; Lay Lateral for Commercial/Industrial ,
Y Building of acres
Connection will be made with `` P VC s o- 35
Existing Water Supply: Public Water Well
.,._ _
Proposed Start DateL Estimated time for completion
ALL WORK TO BE IN ACOORDANCE WITH.TOWN OF SOUTH WINDSOR STANDARDS,
s ALL OSHA REQUIREMENTS AND CONDITIONS ATTACHED TO THE PERMIT
mit 6�1f1i E Per fz
IS to be issued to th older of Drain
y. Layer's License No. o Zo�?z r Only holders of P 1 P- . W-9 licenses
will be issued a permit PERMIT WILL EXPIRE THIRTY(30j AYS AFTER
DATE OF ISSUANCE. The under
signed 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. - c2 Ols Z ¢7 lFA SANITARYSaWER-LA TERAL
IS WITHIN75 FEE T O.FA WELL
IT Nil
STBEA,tR TESTED
Signed: -Print Name:
Li used Drain Layer
Date: - ¢ - /s7
Standard FoinsXPermits\APPLICATION FOR DRAIN LAYERS PERMIT.doC
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TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: g12117 f
BUILDING ADDRESS
STREET
SUBDIVISION:
NORTH ARROW
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CONTRACTOR ( RINT) NAME OF CO CTOR'S SUP R OR (PRINT)
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STREET ADD///RESS SIGNATURE
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TOWN STATE ZIP INSPECTED BY TOWN
So S-7 l-U lL DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER