HomeMy WebLinkAboutDrain Layers Permits 120 Foster Road (2) 1500049 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 08/25/2015
GIS ID: 33300120 FEE: 60.00
MUNIS APPLICATION# 201501144 EXPIRATION DATE: 09/24/2015
APPLICANT ; - LOCATION
NAME: HOMEOWNER =" -' ADDRESS: 120 FOSTER ROAD
ADDRESS: SOUTH WINDSOR, CT06474 OWNER: MANNAI IN0 LISA
Al
120 FC?STR RD
SOUTH DSOR,CT 06074
PHONEYl
WORK DESCRIPTION: DISCONNECT SANI`I"ARY SIlVERLINE TO BACK BUILDING ON PROPERTY
THE DRAIN LAYER ASSIGNED TO THIS 1sRMIT.II1S A VALID-LII;NSE I�SUED"BY TIII SATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORTKli.h'HE`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 I SPECTED INSPECTED BY
8/25/2015 4:17 PM
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO:; CONTRACTOR: VN-e
LOCATION: /,�O CsIL 9L20 J
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TYKE OF WORK: �1,S/�in}�,o�� �✓�� .�.��f .�P�,� i e�-e 7`b �/�- y.
DATE INSP NEEDED: DATE INSP:_
INSPECTED BY: P
WORK IN
PROGRESS: 9-^e-
Bf
SEPTIC TANK PUMPED, HED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: DATE:
S/molloy/forms 2014 Town of South Windsor INPSECTION REPORT 14
?fv t 50114q- 5A 1q4 -* Z439 0 rq2rv.r
APPLICATION FOR DRAIN LAYER PERMIT ,
TOWN OF SOUTH WINDSOR
1540 SUL.LNAN.AVENUE
PUBLIC WORKS DEPARTMENT
SOUTH WINDSOR,CT-
FEE$60.00
.Location of proposed work:-1 O Faster t Lat#
Stred No. Street Name
'Premises owned by: Cra %eh,S e uo. n
Name of Firm: Phone: too 9�� ag
Address of Rrm:
'ryPE OF Wows: I36v%Jah trhe—
Lay House Drain- Repair House Orairt
Lay Main_; Lay Lateral for Commercial/IrulusWal
Building of acres
- Cmnection will be made with
E ing Water Supply: Punic Water_ Well
Proposed Start Da Estimated time for completion i we e K
ALL WORK TO BE IN ACCORDANCE WITH.TTOWN1 OF SOUTH WINDSOR STANDARDS,
ALL OSHA.REQUIREMENTS AND CONDTRONS ATTACHED TO THE PERMIT
Paxmit is to be issued W Cra, MCA the holder of Drain
Layer's Lion No. Only hoklers of 1-1, P-7. or W-9 licenses
will be issued a permit. PERMIT WILL EXPIRE THIRTY(30) DAYS AFTER
DATE OVISSUANCE. The undersigned Drain Layer hereby agrees to all the terms
and conditions set forth in the permit and attached dweto.. Applicant has received
Town Street Excavation Permit No. and/or ConnDOT Permit No.
PLEASE NOTE:
CBYD Wo.. .615 lFA SANITARYSSWER-LATERAL
IS WMrN75FEET OFA WELL
ZTNVSTBEAIR TESTED
.Signed: Print Name: � Iq
h �
Eleenseed�Drain Layer
Date:
Standard Fb ms\Pe Mrt s1APMCAIION FOR t?RAW LAYERS PERW.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: 2&- Ac,4
BUILDING ADDRESS / a
STREET : Fos+eA (2oH�b-
SUBDIVISION:
NORTH ARROW
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CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPER OR (PRINT)
STREET ADDRESS SIGNA
sDATE
TOWN STATE ZIP ;IN CTED BY TOWN
` DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER