HomeMy WebLinkAboutDrain Layers Permits 160 Diane Drive 1600054 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 10/03/2016
GIS ID: 28200160 FEE: 60.00
MUNIS APPLICATION# 201601430 EXPIRATION DATE: 11/02/2016
APPLICANT LOCATION
NAME: WASTEWATER SERVICES/DBA SKIPS ADDRESS: 160 DIANE DRIVE
ADDRESS: 21 COURTNEY DRIVE OWNER: DUBIEE JUANITA N
ELLINGTON,CT 06029 PO$OX531
PHONE
�VLANCHESTER, CT 06045
WORK DESCRIPTION: NEW SEWER CONNECTION
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 FORT14 IN THE,ATTACHED`CONDITIONS'. ALL WORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDARDS,ALL OSHA REOUIREMENTS,AND THE ATTACHED CONDITIONS.
ISSUED BY DATE INSPECTED INSPECTED BY
10/3/2016 12:13 PM
TOWN OF SOUTH WINDSOR INSPECTION REPORT
LOCATION:
TYPE OF WORK:__-_-- i�e,i) we.r..
DATE INSP NEEDED: DATE INSP:
INSPECTED BY:
WORK IN .
PROGRESS: �o � fir s j l� �` PI�� 3
--- �?�t.b •fi o �t'� Sc c�� .�*` �.vc� j4�""� tJtP.i� �r"�'l o%z
LO'S 2-, Af41 Sawwdd A,SEPTIC TANK PUMPED,SMASHED, FILLEDL WITNESSED YES ❑ NO
AS-BUILT:
INPUT: DATE:
S/molloy/forms 2014 Town of South Windsor INPSECTION REPORT 14
APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH VMDSOR
1540 SULLIVMAYME
PUBLIC WORKS DEPARTMENT
TOWN HALL
SOUTH VMDSOR,CT
FEE$60.00
Location of proposedwork:
Street No. Sired Name
Premises owned by: t 1Lz-Z 14 Z 4.
Name of Fin»: / ' leQt-/1I l, ce pho cJ`�✓� .
(V
Address Of Rrm: Z/ �vy�the rl/r �/1!n h►-. / 06oz
TYPE OF WORK:
Lay House Drain— • Repair House Drain.
3:
��Main._,_,; Lay Lateral for CommerdalAndushiai
nj_ of_awes
Connection will be made with s.P�Z 3S
Existing Water Supply: Public Water_ Well
Proposed Start D t S Estimated time for Completion I �s
ALL WORK TO BE IN ACCORDANCE WLTH.MWN OF SOUTH WINDSOR STANDARD,
ALL OSHA.REQUIREMENTS AND CONDITIONS AITACHED TO THE PERMIT
' Permit is to be issued to
. . . Layer's Uc�ense No. o z o�I z s. the holder of Drain .
- Only hollers of P-1, P 7. or W-9 licenses
will be issued a pemif. PERMIT WILL EXPIRE THIRTY(30)DAYS AFTER
DATE OF ISSUANCE. The undersigned Drain Layer hereby agrees to all the tem
and conditions set forth in the pennit and attached thereto.. Applicant has received
Town Sired Eccavation Permit No. and/or ConnDOT Permit No.
OW-No. Z vl 6 3 0/ u �I V S- AL
PLEASE NOTE:
IFA SANIIARY&MR.L4IER
IS WITflIN75 PEE T OF WELL
ZrN16T8EAlR TEb'TED
Signed. Print Name: ,T{ �S
sed Drain Layer
Date: 4
ShmdaW r-oM wffUcnnav Fa ORM LAYRS PSMAOc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: j9 — 6-
BUILDING ADDRESS
STREET
SUBDIVISION:
NORTH ARROW
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CONTRACTOR (PRINT) k. NAME OF CONTRACTOR'S SUPERVISOR (PRINT)
(A,) fcty vit C3 6-a r
STREET ADDRESS SIGNATURE
2.[ eouOAigy b a Elt i,h(�_o IA DATE
TOWN STATE ZIP INSP CTED BY TO /
TELEPHOIlf NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER