HomeMy WebLinkAboutDrain Layers Permits 75 Lexie Lane (2) 1800061 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 08/23/2018
GIS ID: 53450075 FEE: 0.00
MUMS APPLICATION# 201801504 EXPIRATION DATE: 09/22/2018
APPLICANT LOCATION
NAME: ATLANTIC EXCAVATION INC ADDRESS: 75 LEXIE LANE
ADDRESS: 363 PARUM ROAD OWNER: T&1VI,,BUILDING CO INC
110 C?K,STREET
COLCHESTER,CT 06415
PHONE
WORK DESCRIPTION: NEW SEWER CONNECTION BLDG 16 SOUTH WINDSOR WOODS
LEXIE LANE PERMIT FEE COLLECTED ON 201801501
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 BY DATE INSPECTED INSPECTED BY
8/23/2018 9:57 AM
TOWI1i OF MOM,MRNDSOR INSPECTION REPORT
PERMIT NO.: CONTRACTOR:
LOCATION: 6Jda., r. '73
TYPE OF WORK-1
DATE MSP NEED: DACE Ili:
INSPkTi BY
WOW IN
PROGRESS: (21,`Al- I i1Slk&a 4, > s b e 3sy s ru 5
- 74 '
SEPTIC TANK PUMPED, SMASHED, FILLED WMEM ❑-YM [] NO-
AS-BUILT:
INPUT: DATE:
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A F LA UN 1-U ' Y PE I
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $80.00
Location of proposed work: 73, 7 fi ?���r%a`�. Lot # .`�•� ��
Street No. Street Name
Premises owned by: ,, `� C
Name of Firm: - Phone:
Address of Firm: 63�4� w� %�� �� ��C� 7`ei c5C 1i.S
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 /I' 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 _,,o0//�7SS the holder of Drain
Layer's License No. 6500 ry-/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. _e?n�370 Ly477 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
Date: 8' w'?
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 -
BUILDING ADDRESS :
STREET :
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SUBDIVISION:
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CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPERVISOR }
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DATE
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TOWN / ` STATE ZIP INSPECTED BY TOWN
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TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER