HomeMy WebLinkAboutDrain Layers Permits 19 Lexie Lane (2) 1500079 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 11/17/2015
GIS 1D: 53450019 FEE: 0.00
MUNIS APPLICATION# 201501691 EXPIRATION DATE: 12/17/2015
APPLICANT LOCATION
NAME: ATLANTIC EXCAVATION 114C ADDRESS: 19 LEXIE LANE
ADDRESS: 363 PARUM ROAD OWNER: T:&M BUILDING CO INC
15
COLCHESTER, CT 064 110 BROOK STREET
TORRINGTON,CT 06790
PHONE
WORK DESCRIPTION: NEW SEWER.CONNECTION BLDG 17 SOUTH WINDSOR WOODS
PERMIT AMOUNT COLLECTED ON APPL 201501688
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.
ISSUED BY DATE IN PECTED INSPECTED BY
11/18/2015 3:07 PM
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO:: 1,5-ODD CONTRACTOR: Zj ea,?
r oC►TrON' I'9 ���i e cg%-e
TYPE OF WORK: /? ,Oct) 'Sa
DATE INSP NEEDED: DATE INSP:
INSPECTED BY: .b
WORK IN .
PROGRESS:-- oa r : �`1�s "'eve-
SEPTIC TANK PUMPED,SMASHED, FILLED WITNESSED []YES ❑ NO
AS-BUILT:
INPUT:
S/molloy/forms 2014 Town of South Windsor WSEMON REPORT 14
APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
1540 SUL.LIVAUAVENUE
PUBLIC WORKS DEPARTMENT
TOWN HALL
SOUTH WINDSOR,CT
FEE$60.00
-Location of proposed work:7 ?.
Street No. Street Name
'Premises owned by:
Name of Finn:_ /�..7 rc �•� � /.,�.p < �3
}
Address of Mi m:__,
TYPE OF WORK:
Lay House Drain--�L ; Repair House Drair�
Lay Main—______; Lay Lateral for Commerdai/Indusaiai
Building of acres
• Connection will be made Wth t5'l,)X 3, .
E)dsting Water Supply: Public Water. '' Well
Proposed Start D Estimated time for completion ALL WORK TO BE IN ACOORDANCE WnTI TOWN OF SOUTH WINDSOR STANDARDS,
ALL OSHA.REQUIREMENTS AND CONDTRONS ATTACHED TO THE PERMIT
Permit Is to be Issued to C�.�
. ��• ;� the holder of Drain
Layer's License No. o S . Only holders of i-1, P 7. or W-9 licenses
will be Lssued 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 fortis In the permit and attached thereto, Applicant has received
Town Street ovation Permit No. and/or ConnDOT Permit No.
PLEASE NOTE:
CBYD No. a/S• y70/7 / 1FA s.4NzrARrS5WER.LATERAL
IS wnwrN75FEETOFA WELL
lTMI/STBEAIR TESTED
Sign v Print Name:
do
Licensed Drain er
Standard Fomis\Permits\APPUCATION FOR DRAIN LAYERS PERMIT.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: !
BUILDING ADDRESS 17 `
STREET :- 7
SUBDIVISION: �` �
NORTH ARROW
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T~ I
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ON
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CONT ACTOR (PRINT) NAME OF CONTRACTOR'S SUPERVJS (PRINT)
000
STREET ADDRESS SIGNATURE
0
TOWN STATE ZIP INSPECTED BY TOWN
DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER