HomeMy WebLinkAboutDrain Layers Permits 145 Pepin Place (2) 1500068 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 11/04/2015
GIS ID: 70700145 FEE: 0.00
MUNIS APPLICATION# 201501592 EXPIRATION DATE: 12/04/2015
APPLICANT " LOCATION
NAME: ATLANTIC EXCAVATION INC ADDRESS: 145 PEPIN PLACE
ADDRESS: 363 PARUM ROAD: OWNER: T&M BUILDING CO INC
COLCHESTER, CT 06415 110 BROOK STREET
TORRINGTON,CT 06790
PHONE
WORK DESCRIPTION: NEW SBWER CONNECTION BLDG 18
PERMIT'COLLECTED ON APPL 201501587
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- N 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
11/4/2015 2:55 PM
TOWN OF SOUTH WINDSOR INSPEC' ON REPORT
PERMIT NO:: ZLGQQ CONTRACTOR:
LOCATION:
TYPE OF WORK: 10G�
DATE INSP NEEDED: DATE INSP.-_jj
INSPECTED BY: ib
WORK IN
PROGRESS:_
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SEPTIC TANK PUMPED,SMASHED, FILLED WITNESSED 0 YES ❑NO
AS BUILT:_
INPUT: ) DATE:
S/molioy/forms 2014 Town of South Windsor WSEMON REPORT 14
APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH VMD90R
1540 SUUNAUAYENUE
PUBLIC WORKS DEPARTMENT
TOWN HALL
SOUTH WINDSOR,CT
FEE$60.00 �.. e.
L=ft of proposed work. 7 r het#
Street No. Street r4arne
'Premises owned
Name of Finn:_ Phone
Address of Mrm: C3
TYPE OF WORK: /
Lay House Drain y y Repair House Drain
Lay Main; Lay Lateral for CommerdalAndustrial
Building of aches
• Connection will be made with ' 33 R•
Existing Water Supply: Public Watteerr � Well
r�
Propel Start D Estimated time for compleft
ALL WORK TO BE IN ACCORDANCE Wn H.T{OWN OF SOUTH WINDSOR STANDARDS,
ALL OSHA REQUIREMENTS AND COND17MNS ATTAOiED TO THE PERMIT
Permit is tD be issued to, n4 holder of Drain
Layer's License No.add Err Only holders of P-1.. P-7. or 1W9 licenses
will be issued a permiL PERMIT WILL EKPiRE THIRTY(30) DAYS AFTER
DATE OF ISSUANCE. The undersigned Drain Layer hereby agrees t>D all the terms
...and conditions set forth in the permit and attached thereto.. Applicant has received
Town Street Excavatlon Permit No. and/or ConnDOT Permit No.
PLEASE NOTE:
CBYD No. c3/S Vi'o rFA SANITARYShWER•LATIERAL
IS INITHIN75FEETOFA WELL
lTNUSTSEAIR TESTED
Sign Print Name:
y
Licensed Drain r
Date i -Z
�
Startdard Form wermits\APPLICAnON FOR MAIN LAYERS PM MlT.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: //
1� his
BUILDING ADDRESS JJS
STREET
SUBDIVISION:
NORTH ARROW
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INN J
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CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPERVI R (PRINT)
4.
STREET ADDRESS SIGN T ME
—
TOWN STATE ZIP INSPECTED BY TOWN
DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YA i nW - MIQg1 a Twr, FN(:INFFR / nFwi(1PFR