HomeMy WebLinkAboutDrain Layers Permits 1510 John Fitch Blv 1600024. TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 06/01/2016
GIS ID:47701510 FEE: 60.00
MUNIS APPLICATION# 201600707 EXPIRATION DATE: 07/01/2016
APPLICAN LOCATION
NAME: SKIPS WASTEWATER ADDRESS: A510 JOHN FITCH BLVD
ADDRESS: 21 COURTNEY DRFVE OWNER: COUNTY DISTRIBUTORS INC
ELLINGTON,CT 0602 - 1x0I OX 53
SOUTH WINDSOR, CT 06074
PHONE 860-875--M
WORK DESCRIPTION: COMMERICAL-SANITARY REPAIR PROJECT
THE DRAIN LAYER ASSIGNED TO THIS PEKMIT HAS A VALID LICENSE ISSUED BY THE STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FOR -H IN THE ATTACHED--" TION-T, 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 IN PECTED INSPECTED BY
6/1/2016 11:45 AM
- - - -- --- --- --- _--- --
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO:; I 660b7 CONTRACTOR:
LOCATION: 1s/0 k v
TYPE OF WORK: ri'h C &;:2C
DATE INSP NEEDED' DATE INSP: G la2 ),
INSPECTED BY: t3
WORK IN
PROGRESS: Cow_ e dr. L--)isechi`i.erk, F:/re-i
hL U) 1/S
SEPTIC TANK PUMPED, ASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: DATE:
S/molloy/forms 2014 Town of South Windsor INPSECIION REPORT 14
APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
1540 SULLIVAN-AVENUE
PUBLIC WORKS DEPARTMENT
TOWN HALT.
SOUTH WINDSOR,,Cr
FEE$60.00
-Location of proposed work:- /ID j 0� 4 /f/ve/ tA#
meet No. Stroet Name
Premises o ed by:
r
Name of Firm: %S`!c r Ps wli 17 w IrIE2 phone;
Address of Firm: 2( tau 2 T,v C y •A; GTa
TYPE OF WORK: m
Lay House Drain._; Repair House X101,
•
Lay Main_; Lay Lateral for Commerd8VIn lustdal
Building of acres
Connection will be made with
Existing Water Supply: Public Water Well X
Proposed Start Date�.Estimated time for completion
ALL WORK TO BE IN ACOORDANCE W1TH.TOWN OF SOUTH WINDSOR STANDARDS,
ALL OSHA UIREM
AND
ENTS
.� CONDTRONS ATT ACHED TO THE PERMIT
Permit Ls too be issued to the holder of Drain
Layer's Uaense Na Zo 17? z� Only holders of 1�1, P 7. or W-9 licenses
will be Wied a permit -PERMIT WILL EXPIRE THIRTY(30) DAYS AFTER
DATE OF-ISSUANCE. The undersigned Drain layer hereby agrees to all the terms
and conditions set forth in the permit and attached thereto, Applicant has received
Town Sh feet Excavatlon Permit No. and/or ConnDOT Permit No.
PLEASE NOTE:
Cm- -No. 6 Z ° lFA SA/Yllr4RYSkWR LATERAL
IS WnWrN75FEETOFA WELL
F/ rTMVSTSEAIR TESTED
Signed: Print Name:
U nsed Drain Layer
Date:
StwWard Fot7l tmitsWWCATION FOR MAIN LAVERS f-EtNRT.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: '22 /4
BUILDING ADDRESS ISID JDL,
STREET
SUBDIVISION:
NORTH ARROW
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CONTACTOR (PRINT) NAME OF CONTRACTOR'S SUPERVISOR (PRINT)
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� STRE'ET` ADDRESS j SIGNATURE
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TOWN STATE ZIP INSPECTED BY TOWN
DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER.-