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HomeMy WebLinkAboutDrain Layers Permits 9999 Nevers Road (3) 1500044 TOWN OF SOUTH WINDSOR, CT PERMIT NUMBER DRAIN LAYER PERMIT �R o DATE: 07/20/2015 , GIS ID:62409999 MUNIS APPLICATION# 201500947 FEE: 0.00 EXPIRATION DATE: 08/19/2015 APPLICA �< � - - g NAME: HINCKLEY CONST I LOCATION D E S ROAD ADDRESS: 178 HIGHLAND VI F SOUTH WINDSOR SOMERS, CT 06071 S LIVAN AVE PHONE = SOR,CT 06074 A,- WORK DESCRIPTION: NEVER_ N '. THE DRAIN LAYER ASSIGNED TO THI E I S i '# .,ASS 3STATE AND HEREBY AGREES TO ALL THE TERMS AND CONDITIONS SET FOR I RK SHALL BE IN ACCORDANCE WITH THE TOWN OF SOUTH WINDSOR STAND f" ,z `" ATTACHED CONDITIONS. D ISSUED BY DATE INSPECTED INSPECTED BY 9/15/2015 10:09 AM --- ---- -- -- --------- - ------ - -- ------- -- ---- - - ow, }, ; l APPLICATION FOR DRAIN LAYER PERMIT TOWN OF SOUTH WINDSOR 1540 SULLIVAN AVENUE PUBLIC WORKS DEPARTMENT TOWN HALL SOUTH W1NDSOR,CT FEE$60.00 Location of proposed work: # Street No. Street Name 'Premises owned by: /611AI O �. U J P n enT' �n - �S 4= Name of Firm: � Phone: : Address of Firm: � TYPE OF WORK: Y 1 Lay House Drain_; Repair House Drain. Lay Mai ; Lay Lateral for Commercial/Industriai Building of awes Connection will be made with t>(z Existing Water Supply: Public Water �/ Well 4 S Proposed Start Date S Estimated time for completion ol ® S ALL WORK TO BE IN ACCORDANCE WITH,T+DWN OF SOUTH WINDSOR STANDARDS, ALL OSHA REQUIREMENTS AND CONDITIONS ATTACHED TO THE PERMIT Permit is to be issued to-u�ciu s C `G _the holder of Drain Layer's License No, Only holders of P-1.. P-7. or W-9 licenses Will be issued a permit. PERMIT WILL EXPIRE THIRTY(30) DAYS AFTER DATE DF-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 ConnDOT Permit No. PLEASE NOTE: CBYD No. 1FA'SANITARYSEWER-LATERAL IS X'MrN75FEETOFA WELL ITM11STBEAIR TESTED Si ned: 9 -Print Name:hin iet License rain Layer Date:_ Standard FarmsTermiMAPPLICATION FOR DRAIN LAYERS PERMIT.doc TOWN OF SOUTH WINDSOR INSPECTION REPORT PERMIT NO::._Z5- D©L CONTRACTOR: LOCATION: �g 62 e- ye 5 TYPE OF W Z� ORK. � I � 1 d DATE INSP NEEDED: DATE INSP: 2 rs INSPECTED BY: WORK IN PROGRESS: o 1 c4_ipir\ 'W7 S' 2 iAr,o ,1 kA nCkle I K i t S SeR.��c sv►A,� 6' Lc+- GLA �,� -� qr� SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑YES ❑ NO AS-BUILT: INPUT: DATE: S/molloy/forms 2014 Town of South Windsor INPSEMON REPORT 14