HomeMy WebLinkAboutDrain Layers Permits 140 Pepin Place (2) 1500074 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 11/04/2015
GIS ID: 70700140
MUNIS APPLICATION# 201501598 FEE: 0.00
EXPIRATION DATE: 12/04/2015
APPLICANT LOCATION
NAME: ATLANTIC EXCAVATION INC ADDRESS: 140 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 SEWER CONNECTION BLDG 2
PERMIT COLLECTED ON APPL 2015G1593
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.
ISSUED BY DATE INSPECTED INSPECTED BY
11/4/2015 3:38 PM
TOWN OF SOUTH WINDSOR INSPEGTiON REPORT
PERMIT NO.: Is000 CONTRACTOR: A-r)a
LOCATION:.1�/
TYPE OF OF WORK: .SPu�e✓ �'Dir��'k°��J[7n �fC�G1 �•
DATE INSP NEEDED: DATE INSP:
INSPECTED BY: gD
WORK IN
PROGRESS:_ ' - sue use /err SI�IZ '
sd,
SEPTIC TANK PUMPED,SMASHED, FILLED WITNESSED 0 YES ❑ NO
AS-BUILT:
INPUT: DATE:
S/moitoy/farms 2D14 Town of South Windsor WSWWN REPORT 14
APPL:IMnON FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
1540 SULLIVAN.AVENUE
PUBLIC WORI(S DEPARTMENT
TOWN HALL
SOUTH WINDSOR,CT
FEE$60.00
location of propo�l rw?Y #
Street No. Shied Name
. 'PmnIses owned by:
Name of Firm: � Phone: arc r S3,o Yea
Address of Fitin, C.3
TYPE OF WORK:
Lay House Drain �-_� Repair House Drain:. ;
Lay Main ; Lay Lateral for CommerdalAndustrial
Building of awes
Connection will be made with '� S S .
Existing Wafter Supply: Public Wat)eer Well
Proposed Start D i/ S Estimated time for completion
ALL WORK TO BE IN AM)RDANCE WrM TOWN OF SOUTH WINDSOR STANDARDS,
ALL OSHA.REQUIREMENTS AND CONDTIIONS ATTACHED TO THE PERMIT
Permit is to be issued to '
�� ���►�.x .� Qz he holder of Drain
Layer's License NO.0,2d t!?V Y-P7. Only holders of i-1, P-7. or W-9 licenses
will be issued a permit PERMIT WILL EKPIRE THIRTY(30) DAYS AFTER
DATE OF-ISSUANCE. The undersigned Drain Layer hereby agrees to all the germs
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. lPA SANMARYA-WER LATERAL
IS kyn 71rN 75 FEE r OFA WELL
IT NUSTBEAtR TESTED
Sign Print Name:
Ucensed Drain Lay
Date:
SWard Forms\P"tsWMCATION FOR DRAIN LAYERS PMMrr dx
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: l
BUILDING ADDRESSQ? Via?�'' .�-Z �' f
STREET -� r
SUBDIVISION:
NORTH ARROW
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T/���21 1 C k°G Q tR' ,�'Gx/1 �/IC �.� � ( (��
CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUP (PRINT)
STREET ADDRESS SIGNATURE
TOWN STATE ZIP INSPECTED BY TOWN
DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER