HomeMy WebLinkAboutDrain Layers Permits 990 Strong Road (3) 1600031 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 06/15/2016
GIS ID: 87000990 FEE: 60.00
MUNIS APPLICATION# 201600797 = , EXPIRATION DATE: 07/15/2016
APPLICANT LOCATION
NAME: GIGUERE KYLE ADDRESS: 990 STRONG ROAD
ADDRESS: 990 STRONG ROAD OWNER: CLARK STUART D&LAI
SOUTH WINDSOR,CT 06074 990 STRONG ROAD
SOUTH WINDSOR, CT 06074
PHONE
WORK DESCRIPTION: RECONNECT SEWER LATERAL TO NEW HOUSE
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.
ISSUED BY DATE INSPECTED INSPECTED BY
6/15/2016 12:18 PM
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: CONTRACTOR:
LOCATION: S 'fib V)
TYPE OF WORK: `� _
DATE INSP NEEDED: DATE INSP: 4 /S /�
INSPECTED BY:
WORK IN
PROGRESS:
•�,y, ��.r L� �.� I`aGf� �'�'j�` �� :zJrd+l� �ti`r►r� � tti�
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 SULLIVAN-AVENUE
PUBLIC WORKS DEPARTMENT
TOWN HALL
SOUTH WINDSOR,CT
FEE$60.00
: Ication of proposed work:_ 4�2 S rn 12 D� Lot#
Street No. Sbaet Name
ftmises owned
Name of Finn.._ Phone: 86Q 818 2301
Address of Finn: 990
TYPE OF WORK: Ae - 60 k s e w-ev-. ►p
Lay House Drain_
Lay Mai • to Lateral fo HComme Drain.
Y r�/IndusMia
Building of_awes
Connection will'be made with
Existing Wafter Supply: Public Wafter_._._ Wd
ni
Proposed Start Date Estimated time for completion
ALL WORK TO BE IN ACCORDANCE WITH.T+OWL�'OF SOUTH WINDSOR STANDARDS,
ALL OSHA REQUIREMENTS AND CONDITIONS ATTACHED TO THE PERMIT
Permit is to be issued to 4 the holder of Drain
Layer's License Na Only holders of P 1, P-7. or W-9 licenses
will be Issued a permit. PERMIT WILL EXPIRE THIRTY(30) DAYS AFTER
DATE OF ISSUANCE. TMe undersigned Drain Layer hereby agrees t o all the germs
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. lFA SANITARYSMER.LATERAL
tS WITHIN75FEET OFA WELL
lTNVSTBEAIR TESTED
Signed: Pant Name: KX 1 t- G i W k ere
cen DAM Layer �-
Date:
Standard Fwns\Permft\APPLICATION FOR DRAIN LAYERS PERMIT.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS Ila PA
STREET
SUBDIVISION:
NORTH ARROW
i
K yle
CONTRACTOR (PRINT) NAME OF CONTRACT R'S SUPERVISOR (PRINT)
r r�
STREET.`ADDRESS SIGNATU
TOWN STATE ZIP INSPECTED BY TOWN
.- fi s Q t DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER