HomeMy WebLinkAboutDrain Layers Permits 146 Pepin Place (2) 1500084 TOWN OF SOUTH WINDSOR
PERMIT NUMBER C T
DRAIN LAYER PERMIT
DATE: 11/18/2015
GIS ID: 70700146
MUNIS APPLICATION# 201501699 - FEE: 0.00
EXPIRATION DATE: 12/18/2015
APPLICANT
NAME: ATLANTIC EXCAVATION INC - LOCATION
ADDRESS: 363 PARUM ROAD= ADDRESS: 146 PEPIN PLACE
OWNER:COLCHESTER, CT:06415 T&M BUILDING CO.,INC.
110 BROOK STREET
PHONE - TORRINGTON, CT 06790
WORK DESCRIPTION: NEW SEWER CONNECTION FOR BLDG 3 SOUTH WIND 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.
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ISSUED BY DATE INSPECTED 11i18i2015 Io:o9AM INSPECTED BY
TOWN OF SOUTH WINDSOR INSPECT30N REPORT
PERMIT NO -00®5 CONTRACTOR: / n /c � �
LOCATION: 1 La i n �ii�c�
'TYPE OF WORK: (7-0 V)
DATE INSP NEEDED: DATE INSP:.�i
INSPECTED BY:
WORK IN
PROGRESS:_Gvr k-IcAp- sA t d *'ryim sty r- 3-s .
• T
SEPTIC TANK PUMPED,SMASHED, FILLED WITNESSED DYES ❑NO
AS-BUILT:
INPUT:_ DATE: r a " 5
S/mo8oy/foims 2014 Town of&wm Windsor MSMTM REPORT 14
APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOM WINDSOR
1540 SULLIVANAVENUE
PUBLIC WORKS DEPARTMENT
TOWN HALL.
SOUM WINDSOR,CT
FEE$60.00
vocation of proposedwork:_ s sol
Street No. Street Name
-Premises owned by: /;,`•-�V �s
Name of Firm: a�/„ Phone: -&C--�3
Address of Firm: , 3�3 *�.�.n �� -��,- C Z cam'Y/S
TYPE OF WORK:
Lay House Drain : Repair House Drain
Lay Main ; Lay Lateral for Commerdai/Industrial
Building of awes
• Connection will be made with RUC
E)Mng Water Supply: Public Water � Well
Proposed Start Date !�A Estimated time for completion _
ALL WORK TO BE IN ACCORDANCE WITH.TOWN OF SOUTH WINDSOR STANDARDS,
ALL OSHA REQUIREMENTS AND CONDITIONS ATTACHED TO THE PERMIT
* .
Permit is to.be issued to �'.l, �s -77 Z� Z- the holder of Drain
Layer's License No.Q2 ?sMZ V -- 7. Only holders of P-1, P-7. or W 9 Ilcenses
will be issued a permit. .PERMIT WILL EVIRE THIRTY(30) DAYS AFTER
DATE aF 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 6ccavation Permit No. and/or ConnDOT Permit No.
PLEASE NOTE:
CBYD No. a/ ,14"7c z 77/ lFA*SAIYITARYShWER•LATERAL
IS 99WN 75 FE4-7 OFA WELL
ITML6TBEAIR TESTED
SignecPrint Name:
Licensed Drain lair y
Dane:
Standard rbMt MJt5XWUCATION FOR DRAW LAYERS PERW doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS "cc-
STREET T®`
SUBDIVISION: � �C -
NORTH ARROW
Of
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CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPERVISOR (PRINT)
STREET ADDRESS SIG ATURE
c:lfl/a-04/"a170C
TOWN STATE ZIP INSPECTED BY TOWN
5%aZD,' DATE
TELEPHONE NUMBER
U11 IITP