HomeMy WebLinkAboutDrain Layers Permits 11 Lexie Lane (2) 1500082 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 11/17/2015
GIS ID: 53450011 FEE: 0.00
MUNIS APPLICATION# 201501695 EXPIRATION DATE: 12/17/2015
APPLICANT LOCATION
NAME: ATLANTIC EXCAVATION INC ADDRESS: 11 LEIE LANE
ADDRESS: 363 PARUM ROAD ; OWNER: T&M BUILDING CO INC
COLCHESTER, CT-06415 110 BROOK STREET
TORRINGTON, CT 06790
PHONE
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.
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ISSUED BY DATE INSPECTED INSPECTED BY
1 1/1 7/201 5 4:24 PM
TOWN OF SOUTH WINDSOR INSPEC 17ON REPORT
PERMIT NO;: �l CONTRACTOR: 1 - la)9#6 6,4-lW J,I
LOCATION: Cox/ L e
TYPE OF WORK: 1� YJ✓ �<--�
DATE INSP NEEDED: DATE INSP: I/Z o s'
INSPECTED
WORK IN .
PROGRESS:_ Carib ✓ '-sA j 6 '' PVC sbr� 35
Tri n iG t,,.,c -ho
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED YES ❑ NO
AS-BUILT:
INPUT: DATE:
S/monoy/forms 2014 Tom of South ling DRE'MM REPORT 14
APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
1540 SULLIVMAVENUE
PUBLIC WORKS DEPARTMENT
TOWN HALL
SOUTH WINDSOR,CT
FEE$60.00
Location of proposel work:-
Street No. Strom Name
'Premises owned
r--
Name of Finn.. ,Z22.,,
Address of Iirm:
TYPE OF WORK:
Lay House Dral. . it House Drat •n , Reps n •
Lay Main ; Lay Lateml fbr Qrnmerdai/Industriai
Building of awes
Connection will be made with
Existing Water Supply: Public Wafter �-' _ Well
Proposed Start D EsBmated time forcompletion
ALL WORK TO BE IN ACOORDANCE WITH.TOWN*OF SOUTH WINDSOR STANDARDS,
ALL OSHA.REQUIREMENTS AND CONDTRONS ATTACHED TO THE PERMIT
Permit is to be issued to C�r, � �,Y the holder of Drain
Layer's License No. 95F V- Only holders of P-i, P-7 or W-9 licenses
will be issued a permIL PERMIT WILL EXPIRE THIRTY(30) DAYS AFTER
DATE OF-ISSUANCE. The undersigned Drain Layer hereby agrees to all the terns
and conditions set forth in the permit and attached thereto, Applicant has receives!
Town Street Excavation Permit No. and/or ConnDOT Permit No.
PLEASE NOTE:
CBYD-No. tea/5- P,7o/7 ,/ TFA"SANITARYSEWER1A7ERAL
IS WITHIN75 FEE T OF WELL
ITNVSTEEAIR TESTED
Sign Print Name:
Licensed Drain er
Date:— .
standard FonnWmnts�AppumnON FOR msm LAYERs Pmmrr.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: &Jor
d
BUILDING ADDRESS 17 (J-0.
STREET :- /o�
SUBDIVISION: u �
NORTH ARROW
ot
Ph— / it
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4.
CONT ACTOR (PRINT) NAME OF CONTRACTORS SUPER111) (PRINT)
STREET ADDRESS SIGNATURE
TOWN STATE ZIP INSPECTED BY TOWN
?Co r 37— O DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER