HomeMy WebLinkAboutDrain Layers Permits 158 Pepin Place (2) 1500087 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 11/18/2015
GIS ID: 70700158
MUNIS APPLICATION# 201501702 FEE: 0.00
EXPIRATION DATE: 12/18/2015
APPLICANT LOCATION
NAME: ATLANTIC EXCAVATION INC ADDRESS:- 158 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 SOUTH WINDSOR WOODS
PERMIT"AIVIOONT COLLECTED ON APPL 201501604
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 11/18/2015 11:31 AM DATE INSPECTED INSPECTED BY
TOWN OF SOUTH WINDSOR INSPEC130N REPORT
PERMIT NO:: CONTRACTOR: A7-la`&L/
LOCATION: > 5 Le N1AC
'TYPE OF WORK:
DATE INSP NEEDED: DATE INSP:� Q/_/j
INSPECTED BY: n
WORK IN
PROGRESS: c 4.- ��,t s l-�fC�d rr pvc- s 2 3!
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SEPTIC TANK PUMPED,SMASHED, FILLED WITNESSED 0 YES ❑NO
AS-BUILT: � � •
INPUT: DATE:_I
S/molioy/forms 2o14 Town of South wndw INPSmT=REPORT m
APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
1540 SULLIVAN-AVENUE
PUBLIC WORKS DEPARTMENT
TOWN HALL
SOUTH WINDSOR,,CT
FEE$60.00
. : .Locafion of proposal wairk:/ !SQ'�
�& Let#
Stret No. Stmet Name
'Premises owned by:
Name of Firm: 7`i
Address of Mrm:.3:;�; ,U,� �� -�Cr C 7
TYPE OF WORK:
Lay House Drain Repair House Drain------;
Lay Main_____,__; Lay Lateral for Commercial/Industrial
Building of r acmes
Connection will be made with
Basting Water Supply: Public Water= Weil
Proposed Start Date xlZ/.FZ/ZEstimated time for cnmpledon
ALL WORK TO BE IN ACCORDANCE WITH,TOwNbis SOUTH WINDSOR STANDARDS,
ALL OSHA REQUIREMENTS AND CONDnmNS ATTACHED TO THE PERMIT
Permit is to.be issued to CA e Z s the holder of Drain
Layer's License Na Q2�2 d&Z �. 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 terms
and conditions set forth in the permit and attached them.. Applicant has received
Town Street Excavation Permit No. and/or ConnDOT Permit No.
PLEASE NOTE:
CBYD No. TFA'SANITARYSEWR-LATERAL
IS WITHIN75FERT OFA WELL
rrMUSTHEA rR TESTED
Sign Print Name:_
Licensed Drain lair
Date:
—Zzz;z
Stmda[d FbmdWem svPPuCA7mN POR t1m LAYERS PERMIT-doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS
STREET
SUBDIVISION:
NORTH ARROW
I
.
I i
-71
CONTRACTOR (PRINT) NAM_E OF CONTRACTORS SUPERVISOR (PRINT)
STREET ADDRESS SIG ATURE
TOWN STATE ZIP INSPECTED BY TOWN T
2 -- ® !�/e9 DATE
TELEPHONE NUMBER