HomeMy WebLinkAboutDrain Layers Permits 128 Pepin Place (2) 1500071 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 11/04/2015
GIS ID: 70700128
MUNIS APPLICATION# 201501595 FEE: 0.00
EXPIRATION DATE: 12/04/2015
APPLICANT LOCATION
NAME: ATLANTIC EXCAVATION INC ADDRESS: 128 P- PLACE
ADDRESS: 363 PARUM ROAD OWNER: T&-M BUILDING CO INC
COLCHESTER, CT'06415 11 Q 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 OSHAREQUIREMENTS,AND THE ATTACHED CONDITIONS.
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DATE INSPECTED 1 ED INSPECTED BY
11/4/2015 3:23 PM
TOWN OF SOUTH WINDSOR INSPEC17ON REPORT
PERMIT NO:: DD?� 7 CONTRACTOR: t {%b�}� 6��G�'�a
LOCATION: is �P�i n �l �f
TYPE OF WORK: c,J
DATE INSP NEEDED: DATE INSP:
INSPECTED BY: 8D
WORK IN
PROGRESS: K s Lc. C
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SEPTIC TANK PUMPED,SMASHED, FILLED WITNESSED CJ YES ❑ NO
AS BUILT:
INPUT: DATE:
S/mdbyg ms 2014 Town of South Windmr INPSEGm REPORT m
APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
1540 SULLIVMAVENUE
PUBLIC WORKS DEPARTMENT
TOWN HALL
SOUTH WINDSOR,CT
FEE$60.00
: .Location of proposed wa�rk:yy > t
Street No. Stint Name
'Premises owned by:
Name of Rrm: ��_ �74c. � R � Phone: S�C3,S 'o yea
Address of Firm: 7C . r• !
TYPE OF WORK:
Lay House Drain Repair House Drain
Lay Main________; Lay Lateral for Commerdal/Indusbial
Building of acres
• Connection will be made with
Existing Water Supply: Public Water_ Well
Proposed Start Date S Estimated time for completion
ALL WORK TO BE DV ACCORDANCE WTTH.TOWN OF SOUTH WINDSOR STANDARDS,
ALL OSHA,REQUIREMENTS AND CONDTRONS ATTACHED TO THE PERMIT
Permit is to be issued to��/- Ae,,� holder of Drain
Layer's License No.o-vd�ry Y-P7.. Only holders of P-1,P 7. or W-9 licenses
will be issued a permit .PERMIT WILL EXPIRE THIRTY(30) DAYS AFTER
BATE-OF ISSUANCE. The undersigned Drain Layer hereby agrees to all the tears
and conditions set forth In the permit and attached thereto, Applicant has received
Town Street Bomvation Permit No. and/or ConnDOT Permit No.
PLEASE NOTE:
' CBYD No. rFA'SrANTIARYSBWR.LA TERAL
MKITMtM75FEETOFA WELL
1TMUST5EAlR TESTED
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Sign Print Nam /C e: �.�� Lr
t:
Licensed Drain Lay
Date:
StfWard Farms\PermiLs WLICAn0N FOR DRAIN LAYERS PERKM doc
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TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS /d? /�? / d ,�? ;
STREET --�
SUBDIVISION:
NORTH ARROW
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CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUP (PRINT)
STREET ADDRESS SIGNATURE
TOWN STATE ZIP INSPECTED BY TOWN
DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER