HomeMy WebLinkAboutDrain Layers Permits 79 Glenwood Road 1500026 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 06/09/2015
GIS ID:35700079. FEE: 60.00
MUNIS APPLICATION# 201500678 `- EXPIRATION DATE: 07/09/2015
APPLICANT, ;LOCATION
NAME: SKIPS WASTEWATER ADDRESS: 79 GLENWOOD ROAD
ADDRESS: 21 COURTNEY DRIVE OWN R: L£1 IDONRAYMOND G
ELLINGTON,CT 06029 79 GEENOOD ROAD
SOUTH WNDSOR,CT 06074
PHONE 860-875-2 32-
WORK DESCRIPTION: NEW SEWER CONNECTION
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 FORTH IN THE ATTACHED`CONDITIONS'. ALL WORK SHALL BE IN ACCORDANCE WITH
THE.TOWN OF SOUTH WINDSOR STANDARDS.ALL OSHA REOIIIRFMFNTS_AND THE"ATTAC,HF,D CONDITIONS.
ISSUED BY DATE INSPECTED INSPECTED BY
6/9/2015 8:58 AM
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO:; .S CONTRACTOR:!' 7O:` &5
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LOCATION: 19 lei 0 D Qa� — - --
TYPE OF WORK:
DATE INSP NEEDED: DATE INSP:
INSPECTED BY: ig-D
WORK IN
PROGRESS: P yc. 5!i re 3 5' Irf" S4-,4
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041
atily'n
SEPTIC TANK PUMPED, SMASHED, FILLED - WITNESSED YES ❑ NO
AS-BUILT:
INPUT: - DATE:
S/molloy/forms 2014 Town of South Windsor INPSEMON REPORT 14
APPLICATION FOR DRAIN LAYER PERNIT - — -
MWN OF SOUTH WINDSOR
1540 SULLIVM AVENUE
PUBLIC WORKS DEPARTMENT
TOWN HALL
SOUTH WINDSOR,CT
FEE$60.00
Location of proposed work: 7 9 G� woaD 12?> Lot#
Street No. Sint Name
Premises owned by.--- X4 f ""V Do4
Name of Firm: ¢'��F� c✓ �9 • 86o —87.r�- 2 3 3 Z
• Phone.
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Address of Firm. �'c �-�NG� nl
TYPE OF WORK:
Lay House Drain ; Repair House Drain
Lay Main ; Lay Lateral for Commerclai/Industrial
F
Building of acres
Connec Uon will be made with ` T vc
Existing Water Supply: Public Wafer Well
Proposed Start Date.- �u^'� r' Estimated time for completion
ALL WORK TO BE IN ACCORDANCE WM.T OWN OF SOUTH WINDSOR STANDARDS,
1 ALL OSHA REQUIREMENTS AND COMMONS ATTACHED M THE PERMIT
Ar
. Permit is to be issued to �6)' k£1L the holder of Drain
Layer's License No. 0 701 -f Only holders of P-1 P-7 or W-9 licenses
will be issued a permlt PERMIT WILL EXPIRE THIRTY(30) DAYS AFTER
DATE OF ISSUANCE. The undersigned Drain Layer hereby agrees to all the tenfns
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:
z CBYD No. IFA SAMIrARYSSWER•LATERAL
IS wn7frN75 FEE T OF WELL
IT NMrSEAtR4' TESTED
Signed: Print Name: l 9S G�41-A- /Z-
Udensed Drain Layer
Date:
St m daed F0M\ftM t WPLICATION FOR DRAIN LAYERS PERM1T.doe
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: G - / { -
BUILDING ADDRESS _ 79
STREET
SUBDIVISION:
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CONTRACTO (PRINT) \\ NAME OF CONTRACTOR'S tUPERVISOR (PRINT)
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STREET ADDRESS SIGNATURE
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PAr
TOWN STATE ZIP INSPECTED BY TOWN
glo -- ox,33A DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER