HomeMy WebLinkAboutDrain Layers Permit 0710 Avery Street (2) 1600088 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 12/06/2016
GIS ID: 06300710 FEE: 0.00
MUNIS APPLICATION# 201601784 EXPIRATION DATE: 01/05/2017
APPLICANT LOCATION
NAME: RH WHITE ADDRESS: 710 AV
ERY STREET
ADDRESS: 41 CENTRAL STREET OWNER: ALLEN�JAMES A&
P O BOX 257 - 710.`AVERY STREET
AUBURN,MA 01501 ,SOUTH WINDSOR,CT 06074
PHONE 508-832-3295
WORK DESCRIPTION: REPAIR SEWER-LATERAL-TOWN PROJECT NO FEE bURING
INSTALLATION OF WATER MAIN - -
THE DRAIN LAYER ASSIGNED TO THIS PERMIT HAS A VALID LICENSE ISSUEIYBY�STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORTH 1N THE ATTACHED`CONDITIONS'. 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 INSPECTED (�,SPtCTED BY
12/6/2016 3:05 PM
TOWN OF SOUTH WINDSOR INSPEC rION REPORT
PERMIT NO.: CONTRACTOR:
LOCATION: w o A�'� -s i-It
TYPE OF WORK:
DATE INSP NEEDED: ��-t3 -(� DATE INSP:
INSPECTED BY: Lei
WORK IN
PROGRESS: �;��,.i F'.. v✓�r vJ�l/VI:.�Szlr � �.�JI t ' '
SEPTIC TANK PUMPED SMASH9P, FILLED !J/A, WITNES5ED ❑YES ❑ NO
AS-BUILT■
INPUT: DATE; i .
Simolloy/forms 2014 Town of ScO Windsor INP=niON`REPW 14
APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR,CT
FEE $60.00
Location of proposed work: 0 Lot # s4 /0
Street No. S6eet
/Name
Premises owned by: �ii12S
Name of sog
Firm:
E Phone: S32-3795
Address of Firm:
TYPE OF WORD:
Lay douse Drain----___; Repair House Drain
Lay Main ; Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made withLPNeO p/1 y;S
Existing Water Supply: Public Water_ Well
Proposed Start Date_$-/3 y/S- Estimated time fbr completion
ALL WORK TO BE IN ACCORDANCE WITH TOWN OF SOUTH WINDSOR STANDARDS,
ALL OSHA REQUIREMENTS AND CONDITIONS ATTACHED TO THE PERMIT
/
PEnnit is to 1��i ued-to
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Layer'stceasei��t :_c�z __P7 fl -httdempf
r•_ licenses
will-beissued a permit. PE IT-WI-L EK--PIft'E THIRT-y
DATE-OF The-undersigned-Drain Layer-laerel green a#1 tie terms
/A/7I'�i{'uft'1� _#; -`LI'IC:-.:permit�17E� eri1-n Arr��Sn�n�'I•i s-- - _
attached.firs
..___ _`.•v4 _ ! 1lLGI.14 !l4i.7 1 r.Vti{(G'{�
Town Street Excavation Permit No. 1 SOD/D6 and/or ConnDOT Permit No.
CBYD No. ._2ols-236a92Z
Signed, _._ Print Nairl{ :
Licensed Drain Layer -
:' ,ms\*mres�A.PPucATioN Fop Dpoj
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: A&+ G 0 13 aQ
BUILDING ADDRESS t -710
STREET hZecj
SUBDIVISION: A',#
NORTH ARROW
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CONTRACTOR (PRINT) NAME OF CONTRACTORS SUPERVISOR (PRINT)
91 C eyvy I s �"
STREET ADDRESS SIGNATURE
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ti C hA ®t 5 _� �� DATE
TOWN STATE ZIP INSPECTED BY TOWN
93 a 3�`15" DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER