HomeMy WebLinkAboutDrain Layers Permits 15 Lexie Lane (2) 1500080 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 11/17/2015
GIS ID: 53450015 FEE: 0.00
MUNIS APPLICATION# 201501692 EXPIRATION DATE: 12/17/2015
APPLICANT LOCATION
NAME: ATLANTIC EXCAVATION INC ADDRESS 15 LEXIE LANE
ADDRESS: 363 PARUM ROAD,: OWNER: T&._M BUILDING CO INC
COLCHESTER, CT__ 110 BROOK STREET
TORRINGTON,CT 06790
PHONE
WORK DESCRIPTION: NEW SEWER CONNECTION BLDG 17 SOUTH WINDSOR WOODS
PERMIT FEE 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.
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ISSUED BY DATt INSPECTED INSPECTED BY
11/17/2015 3:57 PM
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO:: CONTRACTOR:
LOCATION: %
'TYPE OF WORK: a p�. .-
DATE INSP NEEDED: DATE INSP: >s'
INSPECTED BY: P
W RK IN
PROGRESS: �'c vTTra e4v1-" 4,la 14i CQ•f P vc- s-b rc-
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SEPTIC TANK PUMPED,SMASHED, FILLED WITNESSED 0 YES ❑ NO
AS-BUILT:_
INPUT: Ll D�-r`E
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S/molloy/fomu 2014Town ofSwO V41r w DWSECTM REPORT 14
APPLICATION FOP,DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
1540 SUUJVAN.AYENUE
PUBLIC WORKS DEPARTWIT
TOWN HALL
SOUTH WINDSOR,Cr
FEE$60.00
LOCatIOn Of proposed w0&-f2L,7. L� .Ot#
Sued No. Stnest Name
frernises owned by: %gym 7��,e►ect 5.
Name of Arm: �� c Phor:e:
Address of �1s
TYPE OF WORK:
La House Drai � it House Drai •
Y n � � :
Lay Main ; Lay Lateral for Commercial/Industrial
Building of acres
• Connection will be made with 51�i�'
Existing Water Supply: Public Water= Well
Proposed Start D � Estimated time for completion_.
ALL WORK TO BE IN ACCORDANCE WITH.T0WN OF SOUTH WINDSOR STANDARDS,
ALL OSHA.REQUIREMENTS AND CONDIMNS ATTACHED TO THE PERMIT
Permit is to be issued to the holder of Drain
Layer's License No. S . 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. a/. 5- 70/7 lFA'SANZrARYSOWR LATERAL
rs wn7fIN75FE474FA WELL
ITNVSTEEAaTR TESTED
Sign Print Name: ;_/, T 7. oocy
x
Licensed Drain er
Date:
Standard FormWWMitsXAPPLICATtoN FOR DRAIN LAYERS PERMIT.doc-
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: !
BUILDING ADDRESS
STREET
SUBDIVISION: u` •�
NORTH ARROW
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CONT CTOR (PRINT) NAME OF CONTRACTOR'S SUrR/ l (PRINT)
1.�+�RL,-r.�
STREET ADDRESS SIGNATURE
TOWN STATE ZIP INSPECTED BY TOWN
?C0 P c7^ 0 k DATE
TELEPHONE NUMBER
WHITE — TOWN PINK — CONTRACTOR YELLOW — CONSULTING ENGINEER / DEVELOPER