HomeMy WebLinkAboutDrain Layers Permits 5 Shepard Way (2) 1500083 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 11/18/2015
GIS ID: 82600005 FEE: 60.00
MUNIS APPLICATION# 201501694 EXPIRATION DATE: 12/18/2015
APPLICANT LOCATION
NAME: ATLANTIC EXCAVATION INC ADDRESS: 5 SHEPARD WAY
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 SOUTH WINDSOR WOODS BLDG 3
5 SHEPARD"WAY
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 NSPECTED INSPECTED BY
1 1/1 8/201 5 2:17 PM
TOWN OF SOul.nH WINDSOR INSPECTION REPORT
PERMIT NO:: ,� ODNTRACTIR: U%��
LOCATION: 3
JYPE OF WORK:
DATE INSP NEEDED: DATE INSP: r/ei
INSPECTED BY:
WORK ITV
PROGRESS; Xc�
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SEPTIC TANK PUMPED,SMASH, FILLED WITNESSED C]YES No
AS-BUILT:
INPUT: 5� DATE:
S/molloy/forms 2014 Town of South Windsor Mffi 9IOPI REPORT 14
APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
1540 SUL.LIVAN•AVENUE
PUBLIC WORKS DEPARTMENT
TOWN HALL
SOUTH WINDSOR,CT
FEE$60.00
-Lmft of Prop Lot
Street No. Stred Name
-Premises owned by:
Name of Ann: �„ , Q , . � Phone:
Address of Cam'YIS
TYPE OF WORK:
Lay House Drain_._; Repair House Drain
Lay Main : Lay Lateral for Commercial/Industrial
Building--.of_aares
Connection will be made with A�U
Bftng Water Supply: Public Water Well
Proposed Start Der /ZZ/,Z Estimated time for completion /
ALL WORK TO BE IN ACCORDANCE WITH TOW OF SOUTH WINDER STANDARDS,
ALL OSHA.REQUIREMENTS AND CONDITIONS ATTACHED TO THE PERMIT
Permit Is to be issued W �'.� s '—Z, ;� the holder of Drain
Layer's Uaense No. 2cn R� _ 7. Only hollers 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 to all the terns
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:
y CBYD No. _ Q/ ,4�7c l 7 / lFA'SANZrMYSBWER.LATERAL
ISWZrHrN75FEETOFA WELL
ZrNl/STEEAIR?FSTED
Sign Print Name:i�C
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Licensed Drain Weer y
Date: .
SwWaW F MSft nMWUCAT=FM MM LAYERS PERM AOC
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: Z/ 5P
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BUILDING ADDRESS
STREET �•'�
SUBDIVISION: � �°
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NORTH ARROW
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CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPERVISOR (PRINT)
CT
STREET ADDRESS SIG ATURE
TOWN STATE ZIP INSPECTED BY TOWN
S-c?? A ® RP DATE
TELEPHONE NUMBER