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HomeMy WebLinkAboutDrain Layers Permits 73 Lexie Lane (2) 1800060 TOWN OF SOUTH WINDSOR, CT PERMIT NUMBER DRAIN LAYER PERMIT DATE: 08/23/2018 GIS ID: 53450073 FEE: 80.00 MUNIS APPLICATION# 201801501 EXPIRATION DATE: 09/22/2018 APPLICANT LOCATION NAME: ATLANTIC EXCAVATION INC ADDRESS. 73 LEXIE LANE ADDRESS: 363 PARUM ROAD OWNER: T&M OtLDING CO INC 110 BROOD;.STREET COLCHESTER, CT 06415 PHONE WORK DESCRIPTION: BUILDING 16 ff 73,75,,77,79 SOUTH WINDSOR WOODS THE DRAIN LAYER ASSIGNED TO THIS PERMIT 1 AS 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 9:43 AM TOM OF SOUTH'WINDSOR INSPECTION REPORT PERMIT NO.: CONTRACTOR: LOCATION: r '1L3. TYPE OF WORK: Al��� S,�u.�r�2 CodJrl�i iQn DATE INSP NEEDED: DATE INSP: INSPECTED BY: WORK IN PROGRESS: ;.!3 ;+- n.0 Alex SEPTIC TANK PUMPED,SMASHED, FILLED WITNESSED ❑YES ❑ NO- AS-BUILT: INPUT: - DATE: , S/m6lloyfibrm 2Di4 Town of South wmdw Mpswnx*REPORT 14 APPLICATION FOR DRAIN LAYER PERMIT TOWN OF SOUTH WINDSOR PUBLIC WORKS DEPARTMENT TOWN HALL 1540 SULLIVAN AVENUE SOUTH WINDSOR, CT FEE $80.00 Location of proposed work: 7s 7 7 ?� Lot # .`�. /�' Street No. Street Name Premises owned by: `/� Name of Firm:— Phone: 3y—//?� Address of Firm: c5C y/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 .114, 4, 6. R S Existing Water Supply: Public Water Well Proposed Start Date A /2r 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 ���,� � � ,;., the holder of Drain Layer's License No. inO© BSSr4,-z'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. ®/�t �p �,1+57 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: o�a� /r Standard Forms\Permits\APPLICAIION FOR DRAIN LAYERS PERMIT REVISION 3/2018.doc TOWN OF SOUTH WINDSOR SANITARY SEWER LATERAL FIELD LOCATION DATE OF CONSTRUCTION: 41 - Z-3- 1� BUILDING ADDRESS 71 STREET I&A-C, SUBDIVISION: NORTH ARROW - Tq 36 lioll -._, .___ .._...-._...___........_._ i } ; 4 CONTRACTOR (PRINT) NAME OF CONTRACTORS SUPERVISOR,") ST ADDRE S SIGNATURE"' DATE �O TOWN yJ STATE ZIP INSPECTED BY TOWN DATE TELEPHONE NUMBER WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER