HomeMy WebLinkAboutDrain Layers Permit 0370 Avery Street 1600064 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: I 1/07/2016
GIS ID: 06300370 FEE: 60.00
MUNIS APPLICATION# 201601645 EXPIRATION DATE: 12/07/2016
APPLICANT LOCATION
NAME: SKIPS WASTEWATER ADDRESS: 316 AVERY STREET
ADDRESS: 21 COURTNEY DRIVE OWNER: ANGALLS JAY W
ELLINGTON, CT 06029 3293 HAMLET CHAPEL RD
PITTSBORO,NC 27312
PHONE 860-875-2332
WORK DESCRIPTION: NEW SEWER CONNECTION
THE DRAIN LAYER ASSIGNED TO THIS PERMIT HAS A VALID LICENSE ISS-UEY 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 SPECTED INSPECTED BY
11/7/2016 2:38 PM
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO;: 000 CONTRACTOR:
LOCATION:
TYPE OF WORK:
DATE INSP NEEDED.'---:-- DATE INSP: /
INSPECTED BY: R
WORK IN '
PROGRESS: Ste" -a 'may `gib 2
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SEPTIC TANK PUMPED;SMAS , FILLED WITNESSSEDb-Yl5§'E] NO
AS-BUILT:
DATE:
S,/molloyftms 2014 TOM of South Windsor INP MON 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: 3?0 /?y s -1- Lot #
Street No. Street Name
Premises owned by: TO /z a 4-C)
Name of Firm: :Skiff's' l�itSTE �R7" Phone:
Address of Firm: 21 C674�r-14 e y c3/2 �Fk 4- /.J67-o AJ
TYPE OF WORK:
Lay House Drain ; Repair House Drain ;
Lay Main ; Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with 6 ' s-)°C 3 s -7 V c-
Existing Water Supply: Public Water Well
Proposed Start Date 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 -*1' 6v AX_A-'g!/Z_ the holder of Drain
Layer's License No. a z®*7 9 z f . Only holders of P-1 P- 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. ¢/Z 3 PLEASE NOTE:
IF A SANITARY SEWER LATERAL
IS WITHIN 7S FEET OF A WELL
IT MUST BE AIR TESTED
Signe Print Name:
Li used Drain Layer
Date:
Standard FormsTermits\APPLICATION FOR DRAIN LAYERS PERMIT.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: // 1171�olb,
BUILDING ADDRESS : 3 70
STREET : A Vf(c. v (;,1 r e6 T-
SUBDIVISION:
NORTH ARROW
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CONTRACTOR (PRINT) NAME OP CONTRACTOWS SUPERVISOR (PRINT)
STREET ADDRESS SIGNAT RE
DATE
TOWN STATE ZIP INSPECTED BY TOWN
DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER