HomeMy WebLinkAboutDrain Layers Permits 139 Pepin Place (2) 1500067 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 11/04/2015
GIS ID: 70700139 FEE: 0.00
MUNIS APPLICATION# 201501591 EXPIRATION DATE: 12/04/2015
APPLICANT LOCATION
NAME: ATLANTIC EXCAVATION INC ADDRESS: 139'PEPIN PLACE
ADDRESS: 363 PARUM ROAD OWNER: T&M BUILDING CO INC
COLCHESTER, CT 66415 110 BROOK STREET
TORRINGTON, CT 06790
PHONE
WORK DESCRIPTION: NEW SEWER CONNECTION BLDG 18
PERMIT FEE 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 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 DATP INSPECTED INSPECTED BY
11/4/2015 2:51 PM
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TOWN OF SOUTH WINDSOR INSPEMON REPORT
PERMIT NO:: 1,5-000(o -7 CONTRACTOR: 4L,L a)c �kC
LOCATION: I J 9- PC Pj n Pin tee.
TYPE OF WORK:_Llp .�?
DATE INSP NEEDED: DATE INSP: 11 /4r
INSPECTED BY.- I
WORK IN
PROGRESS: &
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Eli
SEPTIC TANK PUMPED,SMASHED, FILLED WITNESSED Fl YES ❑ NO
AS-BUILT:
INPUT:
DATE:
S/molioy/forms 2014 Town of South Undsor INPSEM ION REPORT 14
APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
1540 SULLIVAN-AVffiUE
PUBLIC WORKS DEPARTMENT
TOWN HALL
SOUTH WINDSOR,CT
FEE$60.00
: .glom of proposed work. +yet# ;
Street No. Sh�aet ame
'Premises owned
Phone:
Address of firm.--2C3 /—Z.7, end'
`TYPE OF WORK; /
Lay House Drain 4 Repair House Drain
Lay Main_; Lay Lateral for Commendai/Industrial
Building of—acres
• Connection will be made with
B tTng Water Supply: Public Water � Well
Propose Start Date Estimated time for completion_ =1
ALL WORK TO BE IN ACOORDANCE WITH.TOWN.OF SOUTH WINDSOR STANDARDS,
ALL OSHA REQUI'RREMENTS AND CONDTIIONS ATTAQiED TO THE PERMIT
Permit is to be issued to holder
of Drain
Layer's Ucense No.agw err v.- �7 . Only holders of P-1, P-7. or 1N 9 licenses
will be issued a permit; PERMIT WILL.EXPIRE THIRTY(30) DAYS AFTER
DATE OF-ISSUANCE. The undersigned Drain Layer hereby agree 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:
. CBY- D'No. 06/5"y S'o ZPA'S NITARYSSWER•LA7IERAL
IS W WrN75FE4-T 4FA WELL
II'MVSTBEAIR TiESTED
Sign Print Name:
l•• ,Cr!
. Y
Licensed Drain lar
Date:._,
standard R mswmit wPUCAnoN FOR t1 m LAYERS Pam.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: 11116' ass
BUILDING ADDRESS /a 131, `35, IJ 31 - / ys ,
STREET
SUBDIVISION:
NORTH ARROW
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CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPERVI R. (PRINT)
STREET ADDRESS SIGMA E
TOWN STATE ZIP INSPECTED BY TOWN
DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER