HomeMy WebLinkAboutDrain Layers Permits 24 Highland Drive (2) 1500058 TOWN OF SOUTH WINDSOR, CT
PENT NUMBER DRAIN LAYER PERMIT
DATE: 10/16/2015
GIS ID: 42900024 FEE: 60.00
MUNIS APPLICATION# 201501477 EXPIRATION DATE: 11/15/2015
APPLICANT LOCATION
NAME: LANDIE CONSTRUCTION INC ADDRESS: 24 HIGHLAND DRIVE
ADDRESS: 21 CLARK ROAD OWNER: WASSENAR ANNA
BOLTON,CT 06043 24 HIGHLAND DRIVE
SOUTH WINDSOR,CT 06074
PHONE 860-6464305
WORK DESCRIPTION: NEW SEWER.CONNECTION
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 0/1 6/201 5 9:48 AM
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO:; J.T'n 0OJ (J CONTRACTOR: Z a nab!f r'DV �rJGlf/oYl
LOCATION: d q
TYPE OF WORK: /UEcJ SP CO hYvPG4dDY1
DATE INSP NEEDED: DATE INSP:
INSPECTED BY: B D
WORK IN
PROGRESS:_ -4iyi) s, p Vr-
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SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED e'YES ❑ NO
AS-BUILT:
INPUT: DATE:
S/molloy/forms 2014 Town of South Windsor INPSECTION REPORT 14
APPL3CA1ION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
1540 SULUVAIUANEIVUE
PUBLIC WORKS DEPARTMENT
TOWN HALL
SOUTH WINDSOR,CT
FEE$60.00
LAcaUon of proposed work: Lot#
Street No. Street Name
Premises owned by:
Name of Finn: 9n/����_��ysTi( � Phone;8l-
o
Address of Firm:- 2 teVl a L7 d,
TYPE OF WORK:
Lay House DrainZ Repalr.House Drai •
Lay Main Lay Lateral for Commerciai/industdal
Building of_aaes
Connection will be made with Ste` 16
Existing Water Supply: Public Water_._, Well__
Proposed Start Dais�o_� Estimated time for completion
ALL WORK TO BE IN ACCORDANCE WITH.TOWN'OF SOUTH WINDSOR STANDARDS,
ALL OSHA.REQUIREMENTS AND CONDTRONS ATTACHED M THE PERMIT
Permit Is to be issued to 10166 -,A)Ale 014S the holder of Drain
LaWs Lloense No..6 Only holders of P-1.. P 7- or W-9 licenses
will be Lssued a permit. PERM WILL EKP=RE 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 Excavation Permit No. and/or CmnDOT Permit No.
PLEASE NOTE:
` CBYD No. rFA SANTrARySsWER-LATERAL
IS WrffN7SFEET 0FA WELL
c--- ZTNIISTBEAIR 1"ESTED
n
Signed: Print Name:
Licensed Drain Layer
o / �S
Date:_
Swwarrr F PerM t WMCAnoN FOR MAM LAYERS PERM.&C
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS
STREET : /C � Z-n/y
SUBDIVISION:
NORTH ARROW
—17
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CONTACTOR (PRINT) NAME OF CO TRA R'S SUP VISOR RINT)
11-20
STREET ADDRESS SIGNATURE
1a�1�f3..0ATE
TOWN STATE ZIP INSPECTED BY TOWN
el& o �� *> DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER