HomeMy WebLinkAboutDrain Layers Permits 135 Pepin Place (2) 1500066 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER
DRAIN LAYER PERMIT
DATE: 11/04/2015
GIS ID: 70700135
MUNIS APPLICATION# 201501590 FEE: 0.00
EXPIRATION DATE: 12/04/2015
APPLICANT LOCATION
NAME: ATLANTIC EXCAVATION INC ADDRESS:.. 135 PEPIN PLACE
ADDRESS: 363 PARUM ROAD " OWNER: T&M BUILDING CO INC
COLCHESTER, CT fl6415 110 BROOK STREET
PHONE TORRINGTON, CT 06790
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 DATE INSPECTED INSPECTED BY
1 1/4/201 5 2:47 PM
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO::,L,� CONTRACTOR: filthiG f'�r'�n gib
LOCATION: I 3
TYPE OF WORK: fl c,,t2 ,
DATE INSP NEEDED: DATE INSP:
INSPECTED
WORK IN
PROGRESS:_ d ` ,y 19v4
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SEPTIC TANK PUMPED,S W.P, FILLED WITNESSED [I YES ❑ NO
AS-BUILT:
INPUT: BATE:
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APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
1540 SUUJVMAVENUE
PUBLIC WORKS DEPARTMENT
TOWN HALL
SOUTH WINDSOR,Cr
: ;rdv, $FEE$660.00`0.
: Location of proposed works
Street No. %eet dame
•Prernises owned
r--- c�7' S3 S��
Name of Firm: , Phone.
� � �- - ;sy, --
Address of Fifth:
TYPE OF WORK:
Lay House Drain_ „ Repair House Drain
Lay Main___--- tray Lateral for Commerdal/Industrial
Building of aces
r
• Connection will be made with _(::7 5',�.�,31
Bdsting Water Supply: Public Water �� Weil
Proposed Start Z Estimated time for completion �~
ALL WORK TO BE IN ACCORDANCE WITH,TOWN OF SOUTH WINDSOR STANDARDS,
ALL OSHA.REQUIREMENTS AND CONDTRONS ATTACHED TO THE PERMIT
Permit Is to be issued to y.-x. A �eCama,.
l the holder of Drain
LaYerrs Lfaense No.a za irtr-v- 27_•• Only holders of t-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 them.. Applicant has received
Town Sb d Excavation Permit No. and/or ConnDOT Permit No.
PLEASE NOTE:
CBYD'No. a26/5-fr yer/�,�r' IFA'SANITARYSWR LA7ML
ISWZWrN75AE4-T•Of'A WELL
ZrN1/STEEArR TESTED
Sign Print Name:
Y
Ucensed Drain r
Date:
Ae -/I, r.
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TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION:
�
BUILDING ADDRESS : _Aif:,=_ /ate j 31, 75
STREET
SUBDIVISION:
NORTH ARROW
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CONTRACTOR (PRINT) NAME OF-CONTRACTOR'S,SUPERVI R.;(PRINT)
STREET ADDRESS SIG T E
TOWN STATE ZIP INSPECTED BY TOWN
DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YFI I nW — rONCI 11 TINS FN(;INFFR / nFVFI(1PFR