HomeMy WebLinkAboutDrain Layers Permits 517 Miller Road 1500062 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 11/02/2015
GIS ID: 59700517 FEE: 60.00
MUNIS APPLICATION# 201501567 EXPIRATION DATE: 12/02/2015
APPLICANT LOCATION
NAME: WASTEWATER SERVICES/DBA SRIPS ADDRESS:_ 517'MILLER ROAD
ADDRESS: 21 COURTNEY DRIVE OWNER: ROSE MARK J
ELLINGTON, CT 06029 517 MILLER ROAD
SOUTH WINDSOR,CT 06074
PHONE
WORK DESCRIPTION: NEW SEWER CONNECTION
THE DRAIN LAYER ASSIGNED TO THIS PERMIT HAS A VALID LICENSE ISSUEDBY 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
11/2/2015 9:09 AM
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO:: 1 CAD r CONTRACTOR:
r
LOCATION:—,5-1 11/1 k�42 J C�
TYPE OF WORK: 5e�--je r (70 n ntoe
DATE INSP NEEDED: DATE INSP: 1 3 15-
INSPECTED BY: 6D
WORK IN
PROGRESS: s S��e� (ez� `JYF ,,1 5.4ti rhn. cxc"A �.
4
1- e '' Sc,4. yc+ a i �,
-TaA APE,
SEPTIC TANK PUMPED, SMASHED, FILLED ~WITNESSED 0 YES ONO
AS-BUILT:
INPUT: V' DATE: 5
S/molloy/forms 2014 Town of South Windsor MPSEMON REPORT 14
APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
1540 SUUNAN-AVENUE
PUBLIC WORKS DEPARTMENT
TOWN HALL.
SOUTH WINDSOR,CT
FEE$60.00
•Location of pMp6SW W� � /7 �/Lce2 p Lot#._
Street No. Street Name
Premises owned by: /k 4�1c 7 s E
Name of Ann: fkI F5 G��s ry r2, Phone: 8 -�7 2 33 2
Addrm of Finn: 2/ c atc./z-Mt£ J/z- 4-t n! C7V n/
TYPE OF WORK:
Lay House Drain ; Repair House Drain
Lay Main ;-Lay Lateral fur Commerdai/Indust ial
Building of acres
Connection will be made with Pyc sZ2 3�r
E)Mng Water Supply: Public Water Well
Proposed Start Date 11'2�r Estimated Time for tbmpietion
ALL WORK TO BE IN ACOORDANCE WITH.TOWN OF SOU ni WINDSOR STANDARDS,
ALL OSHA.REQUIREMENTS AND CONDTRONS ATTACHED TO THE PERMIT
Permit is t>D be issued to of Drain
LaWO License No. Q z o 7 7 Z . Only hollers of P- P-7. r IN 9 licenses
will be issued a permit. PERMIT WILL EXPIRE THIRTY(3 AYS AFTER
BATE OF ISSUANCE. The undersigned Drain Layer hereby agrees to all the term.
and conditions set forth in the permit and attached i1mreto.. Applicant has rea*Ved
Town Street l3ccavatlon Permit No. and/or ConnDOT Permit No.
CBYD No. a<r 4 46 ! 7Z / PLEASE NOTE:
ZFA SAN'1TARY&WER LATERAL
IS Wrrf M75FEErOFA WELL
1T Mi6rBEAtR TESTED
Sign Print Name: R ?h`&lr ZQ1gk10E�
c ensed Drain Layer
Date:
StaWWW F=twe mbWPucATION FOR DRAIN LAYERS PERW doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: II 1.3115-
BUILDING ADDRESS : 15 I-4
STREET : M q O -
SUBDIVISION:
NORTH ARROW
--4 _
i
4. I
nE
I
PTA K a KU o c S T►ig, M 1 Kt IL F45 KA E
CONTRACTOR (PRINT) NAME OF CONTRACT RCS UPERVISOR (PRINT)
a 3 Gou cq T ry41� 0� . 0 3 1�S
STREET ADDRESS SIGNATURE
TOWN ^ STATE ZIP INSPECTED BY TOWN
g�6 '�3"lS- O(�'�a DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER