HomeMy WebLinkAboutDrain Layers Permits 124 Pepin Place (2) 1500070 TOWN OF SOUTH WINDSOR, CT
PENT NUMBER DRAIN LAYER PERMIT
DATE: 11/04/2015
GIS ID: 70700124
MUNIS APPLICATION# 201501594 FEE: 0.00
EXPIRATION DATE: 12/04/2015
APPLICANT LOCATION
NAME: ATLANTIC EXCAVATION INC ADDRESS: 124 PEPIN PLACE
ADDRESS: 363 PARUM ROAD OWNER: T&M BUILDING CO INC
COLCHESTER, CT 06415 110 BROOK STREET
PHONE - TORKI _GTON, 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 THE ATTACHED CONDITIONS.
ISSUED BY ATEl NbS P E C T E D INSPECTED BY
11/4/2015 3:18 PM
TOWN OF SOUTH WINDSOR INSPECI3ON REPORT
PERMIT NO::__15'OOO 7 D '
CONTRACTOR. �f�f��fl G ��r ✓�(�>dyL
LOCATION: ' pe i,) 1'19C-e-
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'TYPE OF WORK: 10�
DAT E INSP NEEDED: DATE INSP:
INSPECTED BY:
WORK IN
PRWRESS:_ 'ft ,�.r f x` �mot; �,.► ,n d �, "r ��c_ '�
�_,$" �r�� Snit rl •'lz, Ftio u$:� � ��� e '� .
SEPTIC TANK PUMPED,SMASHED, FILLED WITNESSED []YES ❑ NO
AS BUILT: : r� ~
INPUT: ��1�-- DATE:_ ' k�
S/mdtoy/forms 2014 Town of fta Windsor IPIPSECiTQN wairr 14
APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
1540 SULLIVAN-AVENUE
PUBLIC WORKS DEPARTMENT
TOWN HALL
SOUTH WINDSOR,CT
FEE$60.00
601
LOCabOn of proposed work.. n "L�7t
Sheet No. Street Name
'Premises owned by: -7-74 Z�n /`T13rne`5'
Name of Firm. � � Phone.-,
. . - ���., � c ,zcrsR
Address of Firm:_., 7C.
TYPE OF WORK:
Lay House Drainer Repair House Drain
Lay Main;; Lay Lateral for Commer+dal/Industrial
Building - of_aches
. Connection will be made with '� S S .
Existing Water Suppiy: Public Wateerr__t:�j Well,
Proposed Start Date Av Estimated time for completion
ALL WORK TO BE DV ACOORDANCE WIm,TOwN OF SOUTH WINDSOR STANDARDS,
ALL OSHA.REQUIREMENTS AND OONDTRONS ATTACHED TO THE PERMIT
Permit is W be issued do ! ?,rahe holder of Drain
Layer's LJaense NO.OWE 0 sZrV y-P7 Only,holders of i-1, P-7. or W-9 Ilcenses
will be issued a permit. .PERMIT wILL EXPIRE THIRTY(30) DAYS AFTER
DATE OF-ISSUANCE. The undersigned Drain Layer hereby agrees to all the teens
and eondRions set forth in the permit and attached thereto, Applicant has received
Town Sbeet Excavation Permit No. and/or ConnDOT Permit No.
PLEASE NOTE:
CBYD'No. _mo0/5 yY6//S�c ZFA'SWITARYAWR-LATERAL
IS MVMrN75FEETOFA WELL
ITNIISTBEAIR TESTED
Sign Print Name: .��
Licensed Drain Lay
Date:
standard Formsxftm tswmcArmN FOR()RAIN LAYERS P mff doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS Q? /.2 F' 3-Z ;
STREET -�
SUBDIVISION: 'Sol
NORTH ARROW s
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CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPE (PRINT)
STREET ADDRESS SIGNATURE
—Cf,4 -, E
TOWN STATE ZIP INSPECTED BY TOWN
, .00 DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER