HomeMy WebLinkAboutDrain Layers Permits 154 Pepin Place (2) 1500086 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 11/18/2015
GIS ID: 70700154 FEE: 0.00
MUNIS APPLICATION# 201501701 EXPIRATION DATE: 12/18/2015
APPLICANT" LOCATION
NAME: ATLANTIC EXCAVATION INC ADDRESS: 154 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 AMOUNT COLLECTED ON APPL 201501694
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 INSPECTED INSPECTED BY
11/18/2015 11:25 AM
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO::— CONTRACTOR:_&jai�
LOCATION: ,
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TYPE OF WOPJ(.-.
DATE INSP NEEDED: DATE INSP:
INSPECTED BY: 91N
WORK IN
PROGRESS:_ n,. �
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SEPTIC TANK PUMPED,SMASHED, FILLED WITNES.S�.ED 0 YES ❑ NO
AS-BUILT:
INPUT: DATE:
S/m ft/forms 2014 Town of South Windsor INPSEC m REPORT 14
APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
1540 SUL.LIVMAVENUE
PUBLIC WORKS DEPARTMENT
TOWN HALL
SOUTH WINDSOR,Cr
FEE$60.00
: .Location of proposal SW�,Z?
Strut No. Strom Name
Pxemises owned by: %71/; d �s
Name of term: oO�l„7 Phone: 'c&CQ
Address of�rm:��r �,�.�, C '7`�r C /. C'0 Y/S'
TYPE OF WORK:
Lay House Drain---L--; Reepalr House Drain.
Lay Main--_____; Lay Lateral for CommerdalAndusbial
Building of acres
• Connection will be made with ZG c �5�
Existing Water Supply: Public Water �'� Well
Proposal Start Date Z!i l Estimated time for completion
ALL WORK'PO BE IN ACOORDANCE Wll-H TOWN OF SOUTH WINDSOR STANDARDS,
ALL OSHA.REQUIREMENTS AND CONDITIONS ATTACH®TO THE PERMIT
Permit is to.be issued to ,/��- ; - the holder of Drain
Layer`s License.No.Q2a RE,r y --P 7. Only holders of I-i,P-7. or W-9 licenses
will be Lssued 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 thereto, Applicant has neceived
Town Street Excavation Permit No. and/or ConnDOT Permit No.
PLEASE NOTE:
Y CBY.D No. a/ ,�7c9 ��/ lFA'SANJTARYSEWER LATERAL
IS WIT MIN75FEETOFA WLI
ZTMUSTBEAIR TESTED
Sign Print Name:
Licensed Drain Wei
Date• .
Standard Forms\Pe=t NAMLICATION FOR DRAIN LAYERS PERMIT:doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: , // / S /S
s 171- .
BUILDING ADDRESS
STREET
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SUBDIVISION:
NORTH ARROW
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CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPERVISOR-(PRINT)
STREET ADDRESS SIG_lWURE
TOWN STATE ZIP INSPECTED BY TOWN -
b r c�c32 ® P, DATE
TELEPHONE NUMBER