HomeMy WebLinkAboutDrain Layers Permits 150 Pepin Place (2) 1500085 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 11/18/2015
GIS ID: 70700150 FEE: 0.00
MUNIS APPLICATION# 201501700 EXPIRATION DATE: 12/18/2015
APPLICANT LOCATION
NAME: ATLANTIC EXCAVATION INC ADDRESS: 150'PEPIN PLACE
ADDRESS: 363 PARUM ROAD. OWNER: T&M BUILDING CO.,INC.
COLCHESTER, CT 64,1 110 BROOK STREET
TORRINGTON, CT 06790
PHONE
WORK DESCRIPTION: NEW SEWER CONNECTION BLDG 3 SOUTH WINDSOR WOODS
PERMIT FEE 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
1 1/18/201 5 11:17 AM
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TOWN OF SOUTH WINDSOR INSPEMON REPORT
PERMIT NO;; CONTRACTOR: igY/c
LOCATION: l;� (� L& A ��lt .
Tl(PE OF WORK:. Asvc�_( Y� �
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DATE INSP NEEDED: DATE INSP: / !g i>
INSPECTED BY:
WORK IN
PROGRESS:_ C�K�i�cda.� I�sd�.v L- C,z Pi/ 5 D rz 3 »,
of
SEPTIC TANK PUMPED,SMASHED, FILLED WITNESSED 0 YES ❑NO
AS-BUILT:
INPUT: DATE: 1
S/mo#Wlforms 2014 Tam of South Undw IPIPSE=N REPORT 14
APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
1540 SUL.LI MAVENUE
PUBLIC WORKS DEPARTMENT
TOWN HALL
SOUTH WINDSOR,Cr
FEE$60.00
Location of proposed work:_� - r a e Lot#
Shed No. Strom Name
'Premises owned
Name of Firm., 7�c c Phone: teQ—,2 `/-/1/G
Amass of Firm--2� ,�.�,� ���, c- 'S'/s
TYPE OF WORK:
Lay House Drain----- Repair House Drain
Lay Main,_,_; Lay Lateral for CommeraalAndustrial
Building of awes
Connection will be made with
Existing Water Supply: Public water ��'� Weil
Proposed Start Date Zi/ Estimated time for completion
ALL WORK 70 BE IN ACCORDANCE WITH.TOWN OF SOUTH WINDSOR STANDARDS,
ALL OSHA.REQUIREMENT'S AND CONDITIONS ATTACHED TO THE PERMIT
Permit is to.be issued to C,l r , , the holder of Drain
Layer's License.No.Q2Q RSZ-41 —2 7. Only holders of 1-1, 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 terms
and conditions set forth in the permit and attached thereto.. Applicant has received
Town Street EKcavation Permit No. and/or ConnDOT Perms No.
PLEASE NOTE:
C DD No. a/ ,�70 z 7�/ lFA SANITARYSE"WER LATERAL
IS WITHIN75 FEE T OF WELL
ITMI/STBEAIR TESTED
Sign Print Name:—
Ucensed Drain Wr y
Date:
Star lard FOr=\Permit WPUrA'n0N FOR W N LAYERS Pa MIT.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: - Z/
BUILDING ADDRESS zmg,
STREET
SUBDIVISION: � � - ��a
NORTH ARROW
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CONTRACTOR (PRINT) NAM_E OF CONTRACTOR'S SUPERVISOR (PRINT)
STREET ADDRESS SIG ATURE
TOWN STATE ZIP INSPECTED BY TOWN
5�_ 2 -- ® 11/ DATE
TELEPHONE NUMBER
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