HomeMy WebLinkAboutDrain Layers Permits 9999 Pepin Place (7) 1400009 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 05/01/2014
GIS ID: 70709999 FEE: 60.00
MUNIS APPLICATION# 201400491 EXPIRATION DATE: 05/31/2014
APPLICAMT - LOCATION
NAME: SIMSCROFT ECHO F R-MS ADDRESS: 9999 P PIN PLACE
ADDRESS: P O BOX 581 OWNER: TO
WNF SOUTH WINDSOR
SIMSBURY, CT 06Q70 = 140 SULLIVAN AVE
SOUTHVINDSOR,CT 06074
PHONE 860-651 0214
WORK DESCRIPTION: LAY SE' V -,MAIN AT SOUTH WINDSOR WO_DS PLEASANT VALLEY RD
AND PEP N PLACE;
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,AIL OSHA REQUIREMENTS,AND THE ATTACHED CONDITIONS.
ISSUED BY DATE INSPECTED INSPECTED BY
5/1/2014 2:12 PM
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: j 91)tv�n CONTRACTOR: S1 yfIsL
LOCATION: g9Qq fermi h �
TYPE OF WORK: Lxjei i ia �eot U1 U 9r An
DATE INSP NEEDED: DATE INSP: /5
INSPECTED BY:
WORK IN r
PROGRESS:- �`�vy L—At 's 411 Ser.
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SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: ' DATE:_�u
S/2014 Town of South Windsor INPSEMON REPORT 14
APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $60.00
Location of proposed work: tF99 9 �e_,o/h / /c �P Lot #
Street No. Street Name
Premises owned by: v j inolSo2 %c)r?r S t"j unlace-
Name of Firm.--��,N,.- �.Q �� ►-,, Phone:r uc))toge-`3 3
Address of Firm.,z fiaT ✓,(t�� S ,1�, G�a(�`
TYPE OF WORK:
Lay House Drain ; Repair House Drain ;
Lay Main ; Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with
Existing Water Supply: Public Water V2 Well
Proposed Start Date S - 7 -1Y Estimated time for completion
ALL WORK TO BE IN ACCORDANCE WITH TOWN OF SOUTH WINDSOR STANDARDS,
ALL OSHA REQUIREMENTS AND CONDITIONS ATTACHED TO THE PERMIT
Permit is to be issued to t. G�"'_ the holder of Drain
Layer's License 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. The undersigned Drain Layer hereby agrees to all the terms
and conditions set forth in the permit and attached thereto. Applicant has received
Town Street Excavation Permit No. and/or ConnDOT Permit No.
CBYD No. 2,gk Uoo3S�\
Signed: (- • �-�-�-Z'I" Print Name: E• �1=
Licensed Drain Layer
Date:_.A-:<-;L &>0 zo(-A
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc