HomeMy WebLinkAboutDrain Layers Permits 2019 Ellington Road 1600029 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 06/13/2016
GIS ID: 30302019 FEE: 60.00
MUNIS APPLICATION# 201600786 EXPIRATION DATE: 07/13/2016
APPLICANT LOCATION
NAME: WASTEWATER SERVICES/DBA SKIPS ADDRESS: 201`9 ELLINGTON ROAD
ADDRESS: 21 COURTNEY DRIVE OWNER: KUPCHUNOS PATRICK&ALFRED
ELLINGTON,CT 06029 1969 ELLINGTON ROAD
SOUTH WINDSOR,CT 06074
PHONE
WORK DESCRIPTION: SANITARY REPAIR'
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 OSHA REQUIREMENTS,AND THE ATTACHED CONDITIONS.
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ISSUED BY DATE INSPECTED INSPECTED BY
6/13/2016 3:45 PM
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.; 00c,2 CONT RACTOR:_&pX
LOCATIOW:� fiJ E�1 �
TYPE OF WORK:
DATE INSP NEEDED: DATE INSP: 3 Ile,
INSPECTED BY: lal",
WORK IN
PROGRESS: +•�L.��r .— r �r.: �� •�, �c `
Two
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SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: _ DATE: AitAV"
S/molloy/forms 2014 Town of South Windsor INPSECTION REPORT 14
APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
1540 SUL LIVAU AVENUE
PUBLIC WORKS DEPARTMENT
TOWN HALL
SOUTH WINDSOR,CT
FEE$60.00
•t cation of proposed work: -�D 15 KO 4 7�j#
Street No. Sued Name
'Premises owned by:
Name of Firm (�4,PA.S�I% - ran Phone:
Address of Firm:gin /'le"11 IV tt, bC-C1,4n�1
TYPE OF WORK: c (Iv
Lay House Drain,; Repair House Drain
WY a Lay Lateral for Commerdai/Industrial
Building of acres
- Connection will be made with te-e-n cy
Existing Water Supply: Public Water_ Wt41
Proposed Start D /.3 /6 Estimated time for completion
AL l WORK TO BE IN ACCORDANCE WITH.TOWN'OF SOUTH WINDSOR STANDARDS,
{ ALL,OSHA,REQUIREMENTS AND DONDTIIONS ATTACHED TO THE PERMIT
Permit is tb be issued to -r&lh W At the holder of Drain
Layer's License No. Only holders of P-1, P-7. or W-9 licenses
will be issued a permlt PERMIT WILL EXPIRE THIRTY(30) DAYS AFTER
DATE-OF ISSUANCE. The undersigned Drain Layer hereby agrees W all the terms
and conditions set forth in the permit and attached them., Applicant has received
Town Street Excavation Permit No. and/or ConnDOT Permit No.
�,/ /® PLEASE NOTE:
r} CBYD No. ,/ 70
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Print Name:
Licensed Drain Layer
Date:
Swnda[d Fotms\Penmits\APPL1CA-n0N FOR M41N LAYERS PatMff doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS � 7V
STREET : ��� 12� 7V
SUBDIVISION:
NORTH ARROW
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CONTRACTOR (PRINT) NAME OF ONTRACTOR'S PERVISOR (PRINT)
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// 1STT�REET ADDRESS SIGNATU
TOWN STATE ZIP INSPECTED BY TOWN
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yd O f 0 770 DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER