HomeMy WebLinkAboutDrain Layers Permits 25 Shepard Way (3) 1600050 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 09/09/2016
GIS ID: 82600025 FEE: 0.00
MUNIS APPLICATION# 201601205 EXPIRATION DATE: 10/09/2016
APPLICANT LOCATION
NAME: T&M BUILDING CO.,INC. ADDRESS:, 25-SHEPARD WAY
ADDRESS: 110 BROOK STREET OWNER: T&M BUILDING CO INC
TORRINGTON,CT 06790 110BROOK STREET
TORRINGTON,CT 06790
PHONE 860-883-5910
WORK DESCRIPTION: NEW SEWER CONNECTIONS FOR DUPLEX 25&27 SHEPARDS WAY
SOUTH WINDSOR WOODS
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 INS ECTED INSPECTED BY
9/9/2016 12:24 PM
SIM0110y/fOrmS 2014 Town of SOO Windsor INPSECTION 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: °"�� �` a 7 dl Lot # f 3�
Street No. ,treeet Name
Premises owned by: R, l
Name of Firm: ,��/a,� :Zvc �cau-_4°rP' Phone:Z'6--73
Address of Firm: 3 /tea/,m �C�lC�4s7`ri C', 00 %/S
TYPE OF WORK:
Lay House Drain ; Repair House Drain ;
Lay Main ; Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with 1/c
Existing Water Supply: Public Water zl� Well
Proposed Start Date 2k19 Estimated time for completion l �y
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 the holder of Drain
Layer's License No.0,?oby8'y - R7 . 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. PLEASE NOTE:
IF A SANITARY SEWER LATERAL
IS WITHIN 75 FEET OF A WELL
IT MUST BE AIR TESTED
Signed :0
• Print Name:
Licensed Drain La
Date: l
Standard Forms\Permits\APPLICAIION FOR DRAIN LAYERS PERMrr.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESSvS
STREET
SUBDIVISION:
NORTH ARROW
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4100
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CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPER PRINT).
STREET ADDRE SI ATURE
00 DATE
TOWN p STATE Qom, ZIP INSPECTED BY TOWN
C0 /`t-� DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER