HomeMy WebLinkAboutDrain Layers Permits 79 Lexie Lane (2) 1800063 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 08/23/2018
GIS ID: 53450079 FEE: 0.00
MUNIS APPLICATION# 201801507 EXPIRATION DATE: 09/22/2018
APPLICANT LOCATION
NAME: ATLANTIC EXCAVATION INC ADDRESS: 79 LEXIE LANE
ADDRESS: 363 PARUM ROAD OWNER: T&M.BLIILDING CO INC
110 BRO ' STREET
COLCHESTER,CT 06415
PHONE
WORK DESCRIPTION: NEW SEWER CONNECTION BLDG=16 SOUTH WINDSOR WOODS
PERMIT FEE COLLECTED ON APPL 201961501
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 INSPECTED BY
8/23/2018 10:32 AM
TOIIUJN OF SOUTH IA INDSOR INSPECTION REPORT
PERMIT NO.: CONTRACTOR:
LOCATION: r W. w.
TYPE OF WORK:_jL(A62.S 'Li.�Pf� d►�,� iQn
DATE INSP NEED: DATE INSP: % .�%rt�
INSPECTED BY:
WORK AV
PROGRESS: (2�4 h2w-Ar r 1 4� � �, 35 97-0." S-11t5 4,
SEPTIC TANK PUMPED, SMASH®, FILJ.ED IAm1VEM ❑YES NO-
AS-BUILT:
INPUT: DATE:
*WaWy/f bi=2014 Tom of ftM Wmdsor.WSEtTft Mi lKr 14
A N ILA UN t-U u 1 Y PF
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $80.00
Location of proposed work: 73, 7 r 7 7 7PZ-e,m.1.. Lot # .`/• ��
Street No. Street Name
Premises owned by: /�?
Name of Firm: Phone:
Address of Firm:
TYPE OF WORK:
Lay House Drain ; Repair House Drain ; Sanitary Disconnect
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 Ir
Existing Water Supply: Public Water Well
Proposed Start Date �4F /?' 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 _ ����7�e the holder of Drain
Layer's License No. e:>20 88ftY-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. . a2zT.370 oUS7 PLEASE NOTE:
IF A SANITARY SEWER LATERAL
IS WITHIN 75 FEET OF A WELL
IT MUST BE AIR TESTED .
Sign Print Name:
-e��- L les -772;�c
Licensed Drai yer
Date:
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT REVISION 3/2018.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: 46 " Z-5— 1-
BUILDING ADDRESS ,
STREET : A LAAe,
SUBDIVISION: -
NORTH ARROW
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CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPERVISOR }
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ST ADDRE S49lqK SI
} DATE
TOWNd "J ugSTAATTE ZIP INSPECTED BY TOWN
� / - �l �l DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER