HomeMy WebLinkAboutDrain Layers Permits 132 Pepin Place (2) 1500072 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 11/04/2015
GIS ID: 70700132 FEE: 0.00
MUNIS APPLICATION# 201501596 EXPIRATION DATE: 12/04/2015
APPLICANT LOCATION
NAME: ATLANTIC EXCAVATION INC ADDRESS: 132'PEPIN PLACE
ADDRESS: 363 PARUM ROAD OWNER: T&M BUILDING CO INC
COLCHESTER,CT 06-415 110 BROOK STREET
TORRIN
PHONEGTON, CT 06790
WORK DESCRIPTION: NEW SEWER CONNECTION BLDG 2
PERMIT-COLLECTED ON APPL 201501593
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 T11E ATTACHED CONDITIONS.
� Wtiolln � �
ISSUED BY i D
1 I/4/2015 3:29 PM A E INSPECTED INSPECTED B
TOWN OF SOUM WINDSOR INSPECTION REPORT
PERMIT NO:: CX)o 7,A CONTRACTOR:
LOCATION: Eel(\
-nrPE OF WORK: Corp
DATE INSP NEEDED: DATE INSP:.
INSPC-CTED
WORK IN
PROGRESS! ,Iv, F'VC s'yn S t'r�
SEPTIC TANK PUMPED,SMASHED, FILLED wnwEssED CJ YES ❑No
AS-BUILT.-
INPUT: ' DATE. ` �6L
Molloy/forms 2014 Town of South Windsor MEMON REPORT 14
APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
1540 SULLIVMAVENUE
PUBLIC WORKS DEPARTMENT
TOWN HALL
SOUTH WINDSOR,CT
FEE$60.00
45
: .Location of proposed work:
Stet No. Street Name
'Premises ovine by: `Tf , n //a ones
Name of Firm: ��.,���� � Phone:
Address of Finn:_,,
TYPE OF WORK:
Lay House Drain �� Repair House Drain
Lay Main_; Lay Lateral for 0mmerdai/Industriai
Building of acres
Connection will be made with '' 5 P9 345 .
Existing Water Supply: Public Water vJ Well
Proposed Start D _i/ S Estimated time for completion
ALL WORK TO BE IN ACCORDANCE WITH.-TOWN OF SOUTH WINDSOR STANDARDS,
ALL OSHA.REQLM04ENTS AND CONDTIIONS ATTACHED TO THE PERMIT
Permit is to be issued to ��/��c �✓�►Q,,��,;� Qthe holder of Drain
Layer's License No.oaZd y-P7 Only.holders of P-1, P-7. or W-9 licenses
will be issued a permiL PERMIT WILL EXPIRE THIRTY(30) DAYS AFTER
[iATE OF-ISSUAMCE. The undersigned Drain Layer hereby agrees iD,all the terms
and conditions set forth In the permit and attached thereto, Applicant has received
Town Street Excavation Permit No. and/or ConnDOT Permit No.
PLEASE NOTE:
CBYD No. _moo/�3�yc�//S�' lFA'SANJT4RY&WER LATERAL
IS WITMIN75FERTOFA WELL
1TTM11STBEAIR TESTED
ll
Sign Print Name:�.��
Licensed Drain Lay
Date:-- '
Standafd Form wermiL APPLICATION FOR DRAIN LAYERS PERMIT.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: L
BUILDING ADDRESS /Q? /A2�" 3� �' f Z, ®I
STREET
SUBDIVISION:
NORTH ARROW S�
_ 77-
Ile-
CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPE (PRINT)
STREET ADDRESS SIGNATURE
�
TOWN STATE ZIP INSPECTED BY TOWN
DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER