HomeMy WebLinkAboutDrain Layers Permits 219 Lawrence Road (2) 1600063 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 11/07/2016
GIS ID: 52800219 FEE: 60.00
MUNIS APPLICATION# 201601643 EXPIRATION DATE: 12/07/2016
APPLICANT _ - LOCATION
NAME: BURKE RIDGE CONSTRUCTION LLC ADDRESS: 219 LAWRENCE ROAD
ADDRESS: 354 NIEDERWERFER ROAD OWNER: SULLIVAN ROBERT&TERRA ARNICA
SOUTH WINDSOR;CT 06074 411-NEVERS ROAD
= SOUTH WINDSOR,CT 06074
PHONE
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 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.
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ISSUED BY DATE WSPECTED INSPECTED BY
11/7/2016 12:38 PM
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO:: C (o CONTRACMR:
LOCATION:
TYPE OF WORK: Aleu)
DATE INSP NEEDED: DATE INSP: 3 ��
INSPECTED BY:
WORK IN •
PROGRESS: e-s al, ,, o - -,4' 5'A0 f e� i�L; S1)!? 3 S` Z222-ta
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SEPTIC TANK PUMPED,SMASHED, FILLED WITNESSED ❑YES ❑ NO
AS-BUILT:
INPUT: DATE:
S/molloy/forms 2014 Town of South Wffdmr INPSWaON 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: d ll OQL Lot #
Street No. Street Name
Premises owned by: S V W% 'V Q-n
Name of Firm: VYke Rv d P Cvr3'r�4,4j�o Phone: 9GG 'S�,9'3oo -9
Address of Firm: J�-V &-eJ—efU,-er-Per P d E04 &.,;;rjS or (-'.
TYPE OF WORK: r�
Lay House Drain 1 eS ; Repair House Drain
Lay Main ; Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with
Existing Water Supply: Public Water Well V S
Proposed Start Date Estimated time for completion /b
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 issued4o the holder of Drain
Layer's License No. z ?., ad 7733 -P7 . 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. 16 ya 3�a 1 PLEASE NOTE:
IF A SANITARY SEWER LATERAL
IS WITHIN 75 FEET OF A WELL
IT MUST BE AIR TESTED
Signed: Print Name:__�ay>.��
Licensed Draii Layer
Date: /v Uhl I av I b
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc
; : 1
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: s-�o 16
BUILDING ADDRESS `� t--a Lr eo4yxcc
STREET
SUBDIVISION:
NORTH ARROW
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CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPERVISOR (PRINT)
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STREET ADDRESS SIGNATUR
,Amo c 1 ,-T (�[ "� s / � DATE
TOWN STATE ZIP INSPECTED BY TOWN
2� �c---)\9 - -: c,`p 9 DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER/ DEVELOPER