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HomeMy WebLinkAboutDrain Layers Permits 399 Foster Street (4) 1600011 TOWN OF SOUTH WINDSOR, CT PERMIT NUMBER DRAIN LAYER PERMIT DATE: 03/04/2016 GIS ID: 33600399 - FEE: 60.00 MUNIS APPLICATION# 201600218 EXPIRATION DATE: 04/03/2016 APPLICANT LOCATION NAME: HOMEOWNER ADDRESS: 9SF - TER STREET ADDRESS: SOUTH WINDSOR, T Ob074 OWNER., EI�IDMIKE �7 LOVLAND HILL RD �EIO*1, CT 06066 PHONE WORK DESCRIPTION: CAP SEWED FQRJ�EMO ` THE DRAIN LAYER ASSIGNED TO THIS PERMIT HAS A VALID LICENSE ISSU>�D,BY TIC STATE AND HEREBY AGREES TO ALL THE TERMS AND CONDITIONS SET FORTH IN,THE ATTACHED`CONDITIONS'., ALL CORK SHALL BE IN ACCORDANCE WITH THE TOWN OF SOUTH WINDSOR STANDA�RvS,ALL OSHA REQUIREMENTS,AND T3IE ATTACHED CONDITIONS. ISSUED BY DATE'INSPECTED- INSPECTED BY 3/4/2016 9:45 AM ----- - - - - - - - - TOWN OF SOUTH WINDSOR INSPECTION REPORT PERMIT NO.: f ©a f l CONTRACTOR: er LOCATION: 3 9s t S cif TYPE OF WORK: DATE INSP NEEDED: DATE INSP: 3 17 / INSPECTED BY: gAS WORK IN . PROGRESS:_ A, t l C�.�iia ecl 6 7`AQ 0 r.L;n From SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑YES ❑ NO AS-BUILT: INPUT: DATE: S/molloy/forms 2014 Town of South Windsor INPSEMON REPORT 14 APPLICATION FOR DRAIN LAYER PERMIT TOWN OF SOUTH WINDSOR 1540 SULLNAN AVENUE PUBLIC WORKS DEPARTMENT TOWN HALL SOUTH WINDSOR,,Cr FEE$60,00 : .Location of proposed work:---5 S Lot# Street No. Street Name ftmises-owned by: Name of Firm: Slmlf G©(k FOa n-f Address of Rtm: TYPE OF WORK. Lay House Drain Repair House Drain Lay Main—______; Lay Lateral for CommercialAndustrial Building of acres Connec tlon will be made with Existing Water Supply: Public Water_ Weil_ Proposed Start DateZ Estimated time for completion 07� ` ALL WORK TO BE IN ACOORDANCE WITH.TOWN OF SOUTH WINDSOR STANDARDS, ALL OSHA.REQUIREMENTS AND CONDTRONS ATTACHED TO THE PERMIT Permit IS to be issued to L the holder of Drain Layex's License Na CQ 77-A53- _• Only holdems of P-1, P-7. or W-9 licenses Will be issued a permit PERMIT WILL ©CPIRE THIRTY(30) DAYS AMR DATE OF-ISSUANCE. The undersigned Drain Layer hereby agrees to all the terra and conditions set forth In the permit and attached thereto.. Applicant has received Town Street 6ccavation Permit No. and/or ConnDOT Permit No. PLEASE NOTE: CBYD No. lFA-S4NITARYSBWER LATERAL IS WITHIN75FEETOFA WELL 1TNi6TBEAr TESTED :a Signr Print Name;� C� r}cv. n j- Licensed Drain Layer Date: SWrudard F0wWX rmitsul MCATION FOR DRAIN LAYERS PERKF DC TOWN OF SOUTH WINDSOR SANITARY SEWER LATERAL FIELD LOCATION DATE OF CONSTRUCTION: _3 7�� BUILDING ADDRESSg9 STREET SUBDIVISION: NORTH ARROW 1 I "iDD '7�N) {f I lljJ : t , L J ! I i - i CONTRACTOR (PRINT) NAME OF CONTRACT 'S SUPERVISOR (PRINT) STREET ADDR'ES/S/ ` (� SIGNATURE /7//4 DATE TOWN STATE ZIP INSPECTED BY TOWN DATE TELEPHONE NUMBER WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER