HomeMy WebLinkAboutDrain Layers Permits 211 Sullivan Avenue (2) 1500029 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 06/10/2015
GIS ID: 87300211 FEE: 60.00
MUNIS APPLICATION# 201500700 EXPIRATION DATE: 07/10/2015
APPLICANT CATION
NAME: ENVIRONMENTAL SERVICES ADDRESS: 211 SUL VAN AVENUE
ADDRESS: 90 BROOKFIELD ST OWNER: 2I1REALY ASSOCIATES LLC
S WINDSOR, CT 06074-1202 565`NEiS RD
Solxth�Vin4or, CT 06074
PHONE
WORK DESCRIPTION: SANITARY DISCONNECT
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THE DRAIN LAYER ASSIGNED TO THIS PERMIT HAS A VALID LICENSE ISSUED BY THE S IATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORT14--1N THE ATTACHED`CONDITIONS'.-ALL WORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDARDS,ALL OSHA REQUIREMENTS,ANI21HE,1fiTACHED CONDITIONS.
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ISSUED BY DATE IN PECTED INSPECTED BY
6/10/2015 9:16 AM
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
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PERMIT NO:; !J CONTRACTOR: t211 ,01? / -1 0(S
LOCATION: I/ s fI/V o n 1
TYPE OF WORK:
DATE INSP NEEDED: DATE INSP:
INSPECTED BY:
WORK IN
PROGRESS: ter
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SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: DATE:_, Ss
S/molloy/forms 2014 Town of South Windsor INPSEMON REPORT 14
APPLICATION FOR DRAIN LAYER PERMIT
_ TOWN OF SOUTH WINDSOR
1540 SULUVAN-AVENUE
PUBLIC WORKS DEPARTMENT
TOWN HALL
SOUTH WINDSOR,CT
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FEE$60.00
� .. .Location of proposed work: 2�l S U l!r✓a�1 / yP� Lot
j R Street No. Street Name
p� _
S. . P.remises owned by.--,, -
Name of Firm: CWU'i2,0y) ME n C Phone.�� ��OD
Address of Firm: ® 2Cr�CZ:G f L b �S`r� 4. GLr{�/d S D 7
TYPE OF WORK:
Y Lay House Drain • Repair House Drains
Lay Main • Lay Lateral for Commerdai/Indust ial
Building �of aces J�'�sCoNh�zT S�GJF�
..
- Connection will be made with
Existing Water Supply. Public Water._ Well
Proposal Start Da t f Estimated time for completion a
.ALL WORK TO BE IN ACCORDANCE WITH.TOWN OF SOUTH WINDSOR STANDARDS,
ALL OSHA REQUIREMENTS AND CONDTRONS ATTACHED TO THE PERMIT
f a;' Permit is to be Issued to the holder of Drain
; .
{ Layer's License No. PL(Mi9a b . 6.°" niy 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
a and conditions set forth in the permit and attached thereto.. Applicant has received
=i Town Sheet Excavation Permit No. and/or ConnDOT Permit No.
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3 PLEASE NOTE:
CBYD No. 2 l �' Z 3 D 3 6S; zFA SANTIARYSEWER L4TERAL
IS WITHIN75FEElO.FA WELL
ITMUSrSEArk TESTED
{r� Signed:
Print Name:
Lice ed D in Layer -T
��. Date: •6'-/0-1 -
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X# Standard FbanS eIMMAPPLICA7I0N FOR DRAIN LAYERS PERMfidoc
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TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS
STREET
SUBDIVISION:
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CO CTO (PRINT) NAME OF TRACT V OR (PRINT)
STR DDRESS SIGNATURE
�� Cyr/��f�✓� DATE
TOWN STATE ZIP INSPECTED BY TOWN
6 DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER