HomeMy WebLinkAboutDrain Layers Permits 12 Orchard Hill Dri 1500038 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 06/30/2015
GIS ID: 66900012 FEE: 60.00
MUNIS APPLICATION# 201500827 EXPIRATION DATE: 07/30/2015
APPLICANT = LOCATION
NAME: JAMES THROWE DBA ADDRESS: 12 ORCHARD HILL DRIVE
ADDRESS: 97 RIVERSIDE DRIVE OWNER: WOJCIK=ALTHEA S
VERNON ROCKVILLE;CT 06066 12 ORCHARD HILL DR
SOUTH WINDSOR, CT 06074
PHONE 860-289-0095
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 REQUIREMENTS,AND THE ATTACHED CONDITIONS.
#-0/1 , 1301,jr,
ISSUED BY DATE INSPECTED INSPECTED BY
6/30/2015 8:26 AM
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO:,: 603 CONTRACTOR: 1110ca-5
LOCATION: �a2 (? r e fi ra di /
TYPE OF WORK:
DATE INSP NEEDED: DATE INSP: 13 j
INSPECTED BY:
WORK IN
PROGRESS: 31..-es Td►s-s w e ns!,J'A C.," Sb 2 S
SEPTIC TANK PUMPED, SMASHED, FILLED _WITNESSED YES [:] NO
AS-BUILT: r
INPUT: DATE: -7 1 5
S/molloy/forms 2014 Town of South Windsor INPSEMON REPORT 14
APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
1540 SUl."M AVENUE
PUBLIC WORKS DEPARTMENT
TOWN HALL
SOUTH WINDSOR,CT
I = ;. - FEE$60.00 _
: Location of proposed work. - - - Lit
Street No. Street Name
Premises owned by: a "
Name of Firm: Phone:
1
Address of Firm: It, Cif l rrL�
TYPE OF WORK:
Lay House Drain - • Repair House Drain.
Lay Main Lay Lateral for Commeraal/Industrial
w Building of acres
r Connection will be made with S np 2S
56 Existing Water Supply: Public Water Well
Proposed Start Date2QSid Estimated time for completion
a,pALL WORK TO BE IN ACCORDANCE Wlll�l.TOWN OF SOUTH WINDSOR STANDARDS,
ALL OSHA.REQUIREMENTS AND CONDTRONS 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 Permit No. and/or ConnDOT Permit No.
PLEASE NOTE:
} : CBYD'No..2U S 2l o ae/2s IFA'SANZTAR-YSBWER-LATERAL
IS WITHIN75FMT OFA WELL
3T STBEAIR TESTED
Signed:
Print Name: � 5 ►'�
4
Licensed Drain Layer
�,
Date:. 1
'Stan0ar-d FormsWermitsXAPPUCAWN FOR DRAIN LAYERS PERMIT.doc
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TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: 6 — 3 a — le) /,5-
BUILDING ADDRESS : 0- / a
cvSTREET Or char] 141-1/ tri v-c
SUBDIVISION:
NORTH ARROW
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CONTRACTOR(PRINT) NAME OF CONTRACTOR' SUPERVISOR (PRINT)
STREET /ADDRESS SIGN RE
DATE
TOWN STATE ZIP INSPECTED BY TOWN
U 2,Fr� QO 13S' DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER