HomeMy WebLinkAboutDrain Layers Permits 77 Lexie Lane (2) 1800062 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 08/23/2018
GIS ID: 53450077 FEE: 0.00
MUNIS APPLICATION# 201801506 EXPIRATION DATE: 09/22/2018
APPLICANT LOCATION
NAME: ATLANTIC EXCAVATION INC ADDRESS; 77 LEX1E LANE
ADDRESS: 363 PARUM ROAD OWNED, T&M BUILDING CO INC
110 BROOD STREET
COLCHESTER,CT 06415
PHONE
WORK DESCRIPTION: NEW SEWER CONNECTION MW 16 SOUTH WINDSOR.WOODS
LEXIE LANE PERMIT FEE COLLECTED ON 201901501
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 WORD SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDARDS,ALL OSHA REQUIREMENTS,AND THE ATTACHED CONDITIONS.
ISSUED BY DATE INSPECTED INSPECTED BY
8/23/2018 10:08 AM
TOWN OF SOUTH WINIMR INSPECTY 1 N REPORT
PERMIT NO.: CONTRACTOR:
LOCATION: 6Jda , '72-
zj:,
TYPE OF WORK-0�
DATE MSP NEEDED: DATE INSP: %3/rs
INSPECTED BY:
WORK IN
PROGRESS: 2
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AS-BUILT:
INPUT: DATE:
*WaWJrW=2014 Tim of So h Wmdsor.MPSICtM REPORT 14
Hr LA VI rU ' N LAY FtK
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 -r- 7�Z'e'-`.t. Lot # •`�•�
Street No. Street Name
Premises owned by:
Name of Firm:�� ,��i �o 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
Existing Water Supply: Public Water �� Well
Proposed Start Date Llr 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. e5VO 7Tg!&-,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. 2C_Z1r.37kY57 PLEASE NOTE:
IF A SANITARY SEWER LATERAL
IS WITHIN 75 FEET OF A WELL
IT MUST BE AIR TESTED .
Sign Print Name:
Licensed Drai yer
Dater
8'
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT REVISION 3/2018.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: `6 - Z73- je
BUILDING ADDRESS
STREET A b0 C LAB,
SUBDIVISION: s
NORTH ARROW
36 . r -
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CONTRACTOR (PRINT) o NAME OF CONTRACTORS SUPERVISOR�e }
r
ST ADDRE S SI
DATE
TOWN STATE ZIP INSPECTED BY TOWN
w yJ j/ r DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER