HomeMy WebLinkAboutDrain Layers Permits 49 Shepard Way (3) 1800003 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 01/29/2018
GIS ID: 82600049 { FEE: 80.00
MUNIS APPLICATION# 201800112 EXPIRATION DATE: 02/28/2018
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APPLICANT a =' LOCATION
NAME: ATLANTIC EXCAVATIQN INC F ADDRESS 49 SHEPARD WAY
ADDRESS: 363 PARUM ROAD L' ,5 OWN>1R T&M BUILDING CO INC
COLCHESTER, CT p�q 16 110 BROOK STREET
€ i7WNGTON, CT 06790
PHONE {' t
WORK DESCRIPTION: NEW SEA Y CbNN CTr01 �
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THE DRAIN LAYER ASSIGNED TO THI VEI�IIT HAS A��!1LID L CL I,SE>iSSUEIYB TIC STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FOR`II`I�V THE'-ATTAE15�;CUIDII�Q1vS' AST FORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDAItpS,ALL OSH1;FtEQt�IREMINTS;AfiiD THE ATTACHED CONDITIONS.
ISSUED BY DATE INSPECTED INSPECTED BY
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: 006o_3 CONTRACTOR: s4ko
LOCATION: Sh
TYPE OF WORK:_ f_ Co 0 n&tiz)- -----
DATE INSP NEEDED: DATE INSP: 1 3+ 18
INSPECTED BY:
WORK IN
PROGRESS: G?�N�fa� . , s /1�d G "' f'v� s r�`z rs
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SEPTIC TANK PUMPED, SMASHED, FILLED W3TNESSED ❑ YES ❑ NO
AS-BUILT: '
INPUT: DATE: r
5/mol[oy/farms 2014 Town of South Windsor INPSEMON REPORT 14
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TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $80.00
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Location of proposed work: Lots# 3�
Street No. steeet Name
Premises owned by:
Name of Firm: Phone: 5WO-„�,�y
Address of Firm: ,3C,3 „i� u. i��! /cf�� � ' C��' p?s
TYPE OF WORK:,
Lay House Drain vim; Repair House Drain
Lay Lateral for building with connection ; or no connection ;
Lay Main,_
Lay Lateral for Commercial/Industrial Building number of acres
Connection will be made with
Existing Water Supply: Public Water Well
Proposed Start Date4 3' Estimated time for completion A?-Zz-x
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.o-0o?TT ' P? 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. c0a/2T PLEASE NOTE:
IF A SANITARY SEWER LATERAL
7 IS WITHIN 75 FEET OF A WELL
IT MUST BE AIR TESTED
Signe Print Name:.X,�,/0,7 % dc
Licensed Dr ` ayer
Date: / �2
Standard Forms\Permits\APPUCAT10N FOR DRAIN LAYERS PERMIT'REVISION 2017.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS
STREET
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CONTRACTOR (PR T) NAM OF C( ',TOR"4 SUPERVISOR (PRINT)
STREET ADDRESS SI ATURE
TOWN STATE ZIP INSPECTED BY TOWN
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TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER