HomeMy WebLinkAboutDrain Layers Permits 212 Pepin Place (2) 1700041 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 08/22/2017
GIS ID: 70700212 FEE: 0.00
MUNIS APPLICATION# 201701115 EXPIRATION DATE: 09/21/2017
APPLICANT LOCATION
NAME: ATLANTIC EXCAVATION INC ADDRESS: 212`PEPIN PLACE
ADDRESS: 363 PARUM ROAD OWNER: T&M BUILDING CO INC
COLCHESTER,CT 06415 110 BROOK STREET
TORRINGTON,CT 06790
PHONE
WORK DESCRIPTION: NEW SEWER CONNECTION PERMIT FEE COLLECTED ON
APPLICATION 201701114
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.
ISSUED B DATE INSPECTED INSPECTED BY
8/22/2017 9:30 AM
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: J (L Ll CONTRACTOR: /9IM1,�9I)c,
LOCATION: Q ]d. A I
TYPE OF WORK: NZ°c c� SQC nv� t ran
DATE INSP NEEDED: DATE INSP: ����1
INSPECTED BY: �
WORK IN
PROGRESS: /`VC S-
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: DATE:
S/molloy/forms 2014 Town of South Windsor INPSEMON 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'00i a?io?, o?/6'..ZZo a2� Lot #_ �lqc c
Street No. Street Name
Premises owned by: '
Name of Firm: Phone: YCa
Address of Firm: AC ? ,
TYPE OF WORK:
Lay House Drain ; Repair House Drain ;
Lay Main ; Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with 4 ►ice JSW LK�
Existing Water Supply: Public Water Z,--�Well
Proposed Start Date 9' o? 7 Estimated time for completion 7
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. coo SBfk P 7 . 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. W01�a�a 3� PLEASE NOTE:
IF A SANITARY SEWER LATERAL
IS WITHIN 75 FEET OF A WELL
IT MUST BE AIR TESTED
Signed: Print Name:
Licensed Drain Laye
Date:
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION ,
DATE OF CONSTRUCTION:
'arid
BUILDING ADDRESS d
STREET
SUBDIVISION: i
NORTH ARROW
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CONTRACTOR (PRINT) NAME OF C CTO ER SO
STREET ADDRESS SIG
DATE
TOWN ( [' ,STA E ZIP INSPECTED BY TOWN
DATE
TELEPHONE NUMBER
WHITE — TOWN PINK — CONTRACTOR YELLOW=� CONSULTING ENGINEER / DEVELOPER
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