HomeMy WebLinkAboutDrain Layers Permits 138 Kelly Road 1600089 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 12/07/2016
GIS ID:49500138
MUNIS APPLICATION# 201601787 FEE: 0.00
EXPIRATION DATE: 01/06/2017
APPLICANT LOCATION
NAME: SPAZZARINI CONSTRUCTION ADDRESS: 138 KLLY ROAD
ADDRESS: 50 POST OFFICE ROAD OWNER: PION THOMAS J&ROSELYN A TR
ENFIELD,CT 06082 I38 KELLY ROAD
SOUTH WINDSOR, CT 06074
PHONE 860-745-5683
WORK DESCRIPTION: LATERAL REPAIR NO FEES TOWN PROJECT
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 INSPECTED SPECTED BY
12/7/2016 11:27 AM L`
TOWN OF SOUTH WINDSOR INSPEMON REPORT
PERMIT CONTRACTOR: i-)
LOCATION: 1 LL 11 u, rk
TYPE OF WORK:
DATE INSP NEEDED: DATE INSP:
INSPECTED BY: ! A 0-s-60>
WORK IN "
PROGRESS: CNQ C—D-m J-U yL d (I� OTC o a(((,l VA�. P ,�� Rv�►i �� �osE�r
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SEPTIC TANK PUM D,SMA�H�D, FILLED N/� WITNESSED ❑YES ❑ NO
AS-BUILT: ►
S/molloy/forms 2014 Town of South Windsor INPSIEMI`REPORT 14
APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
1540 SULLIVAN AVENUE
PUBLIC WORKS DEPARTMENT
TOWN HALL
SOUTH WINDSOR, CT
FEE $60.00
Location of proposed work: Lot#
Street No. Street Aame
Premises owned by:
Name of Firm:_ . z. �'l V•., Phone: - `� �G 83
Address of Firm: '35s P 05 r 01 0 �-
TYPE OF WORK:
Lay House Drain : Repair.House Drain :
Lay Main : Lay Lateral for Commerdal/Industrial
Building of acres
Connection will be made with a*, S c>R 3
Existing Water Supply: Public Wate� 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 the holder of Drain
Layer's License No. QLH M?97M Only holders of 014 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.
PLEASE NOTE:
CBYD No. _fl,G/I I L Q IFA SA NJ TA R Y SEWER LATERAL
IS WrrHrN75FEET OFA WELL
TT MUST BEAIR TESTED
Si ned: Af4e � 1
9 Print Name: .✓
Lic rain Layer
Date:
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc
TOWN OF SOUTH WINDSOR
. SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS o u 3
STREET
-I- SUBDIVISION:
NORTH ARROW
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CONTRACTOR (PRINT) NAME OF CONTRACT R'S SUPERVISOR (PRINT)
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STREET ADDRESS SIGNATURE
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TOWN STATE ZIP INSPECTED BY TOWN
" 'CCG (3^ '-? YS _5co DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER