HomeMy WebLinkAboutDrain Layers Permits 17 & 19 Shepard Way (2) 1600007 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 01/19/2016
GIS ID: 82600017 FEE: 60.00
MUNIS APPLICATION# 201600046 „ EXPIRATION DATE: 02/18/2016
APPLICANT LOCATION
NAME: ATLANTIC EXCAVATION INC DRESS- I7� 19 SHEPARD WAY
ADDRESS: 363 PARUM ROAD OWNER TR -UILDING CO., INC.
COLCHESTER, CT 06415 �1�$ROOK STREET
OIiN TON,CT 06790
PHONE
WORK DESCRIPTION: NEW SEWEMCO lECTIOItI FOR 11-&-- 9=SHEPAFRD W�A-Y-
THE DRAIN LAYER ASSIGNED TO THISVERS:4IrKHA A MID LI Lb E ISSUI ISBY THE"STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORTH INTHE A�TACIIEI}3C6NDiTIQN WORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDARDS ALA OSHA REQUIREMENTS A ?TIIE ATTACHED CONDITIONS.
ISSUED BY DATE INSPECTED INSPECTED BY
1/19/2016 9:31 AM
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: �v CONTRACTOR:
LOCATION: I cl z �l✓ � V/'
TYPE OF WORK:__ C�/n lGo
DATE INSP NEEDED: DATE INSP:
INSPECTED BY:
WORK IN .
PROGRESS: L�y fw� � s�.,. IZ (� �'Vc 5DI2. 3 s Fro m
/�? �`o Lea �.oc:�vra•� S '.� y _ rt nr�-5 17
1
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: j— DATE:
S/molloy/forms 2014 Town of South Windsor INPSEMON REPORT 14
APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
1540 SULLIVANAVENUE
PUBLIC WORKS DEPARTMENT
TOWN HALL
SOUTH WINDSOR,CT
FEE$60.00
Location of proposed /?f�jy # !7 -e!
Street No. 96vet Nance
. P.remises owned by: � <
Name of Finn: OIL � Phone: `&'o
Address of F1tm:—.�C',3 C% aC XGCS"
TYPE OF WORK:
Lay House Drain Repair House Drain.
Lay Main_; Lay Lateral for Commerdal/Industrial
Building of aces
Connection will be made with !::;' 5.9Y 3.,.7
Existing Water Supply: Public Water Well
Proposed Start Dak.�Estimated time for completion
ALL WORK TO BE IN ACCORDANCE WLTH.TOWN OF SOUTH WINDSOR STANDARDS,
ALL OSHA REQUIREMENTS AND CONDTRONS ATTACHED TO THE PERMIT
Permit IS to be issued to
. Layer's License No. �Zo the holder of Drain
�,�P7_. Only ho dens of P-1, P-7. or W-9 licenses
will be Lssued a permit PERMIT WILL EXPIRE THIRTY(30) DAYS AFTER
DATE OFISSUANCE. The undersigned Drain Layer hereby agrees to all the terms
and conditions set forth in the permit and attached thweto.. Applicant has rea Wed
Town Sb eet Excavation Permit No. and/or ConnDOT Permit No.
PLEASE NOTE:
CBYD No. 1FA'SANlTARYSkR-447ERAL
IS WlrHrN75FMT OFA WELL
ZrNIISTBEAarR TESTED
Sin �
9 Print Name: ���/,' ,,�c-•
Licensed Drain er
Date:
SWWw.d F PerMit5WP(ICAaON FOP.DRAIN LAYERS PERW.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: /
BUILDING ADDRESS 7
STREET
SUBDIVISION: D 7� � � Via'
NORTH ARROW
:
i ICE
1
00
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All
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CONTRACTOR (PRINT) NAME 0 CONTRACT 'S SUPER : (PRINT)
STREET ADDRE S MATURE
ct� -7� DATE
TOWN STATE ZIP INSPECTED BY TOWN
3 o ` DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER