HomeMy WebLinkAboutDrain Layers Permits 21 & 23 Shepard Way (2) 1600006 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 01/19/2016
GIS ID: 82600021 FEE: 60.00
MUNIS APPLICATION# 201600045 f ;; EXPIRATION DATE: 02/18/2016
APPLICANT LOCATION
NAME: ATLANTIC EXCAVATION INC = = ADDRE 2I`& ,SHEPARD WAY 2
ADDRESS: 363 PARUM ROAD = OWNER f &M$UILDING CO., INC.
COLCHESTER,CT(I64 I I(BROOK STREET
COI I II KITON,CT 06790
PHONE = -
WORK DESCRIPTION: NEW SW ,C }IN �TIOIdT0�1&23EA WAS'
THE DRAIN LAYER ASSIGNED TO THIS:PERMIT HAS A VTD I ICENSI ISSUI D BY THi STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FOR1N THE ATACHI<D` 4Nll1T.IS3M; ALT 1?4ORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STAND ft§ AL_OSHA REC TJIIZEMEIdTS,t N T ATTACHED CONDITIONS.
ISSUED BY DATE INSPECTED INSPECTED BY
1/19/2016 10:29 AM
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: d��y OCR CONTRACTOR: 0 aw Yl,e--
LOCATION: 0- ,2 3 ,S l
TYPE OF WORK: "LO i @, C�r�►-��C' 'lam f�
DATE INSP NEEDED: DATE INSP: /1.27 ,
INSPECTED BY: Ate
WORK IN .
PROGRESS: E, � �.- :h sf 1 Gz Py S' a
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑YES ❑ NO
AS-BUILT:
INPUT:_ DATE:
S/molloy/forms 2014 Town of South Windsor INPSECTION REPORT 14
APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
1540 SULLIVAN-AVENUE
PUBLIC WORKS DEPARTMENT
TOWN HALI.
SOUTH WINDSOR,CT
FEE$60.00
: .Location of proposed work: �/ a 3 �,� # . 37-
Strad No. Sfid Name
'Premises owned by: `Aa.
Name of firm:_ 101; , � cQ.s 'fir Phone: 8_ Y-//7C
Address of Rem:
TYPE OF WORK:
Lay House Drain Repair.House Drain.
_ Lay Maim—____; Lay LVml for Commerclai/Industrial
Building of acres
Connection will be made with � �'
EKNng Water Supply: Public Water well,
Proposed Start D Estimated time for completion f
ALL WORK TO BE IN ACCORDANCE WITH TOWN OF SOUTH WINDSOR STANDARDS,
ALL OSHA.REQUIREMENTS AND CONDTRONS ATTACHED TO THE PERMIT'
Permit is to be issued to As % c. the holder of Drain
Layer's License No. �gre y Only hoidens of P 1,P-7. or W-9 licenses
will be issued a permit. .PERMIT WILL EKPIRE THIRTY(30) DAYS AFTER
DATA OF-ISSUANCE. The undersigned Drain Layer hereby agrees to all the terms
and conditions setforth in the permit and attached thereto.. Applicant has received
Town Street 6ccavation Permit No. and/or ConnDOT Permit No.
PLEASE NOTE:
CSYD No. lFA'SANITARYSSWER-LA TERAL
IS WrrHrN75 FEE T OF WELL
2TN4lSTSEA,tR STED
Sign Print Name: �.Ec�� %',L2:2vt
Licensed D n Layer
Date: i
Standard FWW\ft mats cnn0N FM MM LAYM Pa MA.Cbc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: 11C
BUILDING ADDRESS e27 / a
STREET
SUBDIVISION:
NORTH ARROW
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'T� lic �Ye e
CONTRACTOR (PRINT) NAME OF CONTRACTORS SU RVISO T
STREET ADDRESS SIGNATURE loll
/,��Zp --1 DATE
TOWN STATE ZIP INSPECTED BY TOWN
?CO— 5-32— DATE
TELEPHONE NUMBER
WHITE — TOWN PINK — CONTRACTOR YELLOW — CONSULTING ENGINEER / DEVELOPER