HomeMy WebLinkAboutDrain Layers Permits 554 Ellington Road 1500056 TOWN OF SOUTH WINDSOR, CT
PENT NUMBER DRAIN LAYER PERMIT
DATE: 10/07/2015
GIS ID: 30300554 FEE: 60.00
MUNIS APPLICATION# 201501387 EXPIRATION DATE: 11/06/2015
APPLICANT =; LOCATION
NAME: SAVIOUR SEPTIC LLC. ADDRESS: 554 ELLINGTON ROAD
ADDRESS: 4N 5TH AVENUE OWNER: PRICE LEON
TAFTVILLE, CT 060 , 104 BUNKER HILL RD
ANDOVER, CT 06232
PHONE 860-608-5SK-_
WORK DESCRIPTION: NEW SEWER CONNECTION
THE DRAIN LAYER ASSIGNED TO THI5 PERMIT HAS A VALID LICENSE IS SUE 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
10/7/2015 9:21 AM
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO:: /�f C�p�,S�fr CONTRACTOR: •>`a
LOCATION: J (� �/��✓r A
TYPE OF WORK: 60 rl i�P drt
DATE INSP NEEDED: DATE INSP: ism
INSPECTED BY: r3
WORK IN
PROGRESS: Drz
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SEPTIC TANK PUMPED, SMASHED, FILLED `� WITNESSED ®'YES ❑ NO
AS-BUILT:
INPUT: DATE: O
S/moiloy/forms 2014 Town of South Windsor INPSEMON REPORT 14
APPl ICA71O N FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
1540 SULLIVAN-AVENUE
PUBLIC WORKS DEPARTMENT
TOWN HALL
SOUTH WINDSOR,,Cr
FEE$60.00
Location of proposed work: �S'—.sry �z,���uN zp !ot#
Stra No. Street Name
'Premises owned by: Z x-ory
Name Of Firm: ��9�lt>L. 2 S�PT/ LL P11Vne:
_ � �'�� 038 �Address of Frm: T
TYPE OF WORK:
Lay House Drain X Repair House Drain
Lay Main_; Lay Lateral for Commer+dai/Industrial
Building_ of acres
Connection will be made with
Existing Water Supply: Public Water___*_ Well_
Proposed Start Dat M% is Estimated time for completion �/F� —f
ALL WORK TO BE IN ACCORDANCE WITH.TOWI'Q OF SOUTH WINDSOR STANDARDS,
ALL OSHA_REQUIREMENTS AND CONDTRONS ATTACHED TO THE PERMIT
Permit IS to be issued to A2k /wdtAG J/Z the holder of Drain
Layer's License No. O Y� 6 d 17. . Only holders of p-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 tD all the terms
and conditions set forth in the permit and attached thereto.. Applicant has received
Town Street 6u:avation Permit No. and/or ConnDOT Permit No.
CBYD No. ��l 5 3 �I a � .� $ 1 PLEASE NOTE: .
lFA SANITARYSAWR LATERAL
IS WLTHIIY7SAEET OFA WELL
ZTN11ST8EArR TESTED
Signed: Print Name: k/z
tensed Drain Layer
Date• 9 s l�
Standard Forms\PMmit XWLICA'n0N FOR WJM LAYERS P8 MIT.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: /® - -7 - ,w
BUILDING ADDRESS
STREET : 'Z1,Tiy 7-1p /.) it
SUBDIVISION:
NORTH ARROW
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CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPERVISOR (PRINT)
STREET ADDRESS SIGNATURE
Vic.L e C71 O(. 3" tro l DATE
TOWN STATE ZIP INSPECTED BY TOWN
o ® � - j f®C, DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER