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HomeMy WebLinkAboutDrain Layers Permits 9999 Pepin Place (9) 1800090 TOWN OF SOUTH WINDSOR, CT PERMIT NUMBER DRAIN LAYER PERMIT DATE: 11/28/2018 GIS ID:70709999 FEE: 80.00 MUNIS APPLICATION# 201802323 �3 EXPIRATION DATE: 12/28/2018 'ta APPLICANI , ; t LOCATION NAME: ATLANTIC EXCAVTdQN ETC ADDRESS �99� PPIN PLACE ADDRESS: 363 PARUM ROAD OyUNER r u TOU1{ F SOUTH WINDSOR '> 4 1540 SiJLLIVAN AVE COLCHESTER,CT 0415 4y Ap. PHONE a #� WORK DESCRIPTION: NEW SEWIIG© NLCTTON CI,UBHOUS f >r F 1 35 PEPII��PI � t THE DRAIN LAYER ASSIGNED TO THIS PERIVIIT H S! mu'L�C�NS$dSSLI�U BT THE ESTATE AND HEREBY AGREES TO ALL THE TERMS AND CONDITIONS SET FORTH IN THE ATTACIIEI�`CC}NDT I ON"' ALA y�7 RK SHALL BE IN ACCORDANCE WITH THE TOWN OF SOUTH WINDSOR STANDAYIc9,aL OSHA HE UIREMEN'I�S,AI D TITS ATTACHED CONDITIONS. ISSUED Y DATE INSPECTED INSPECTED BY 11/28/2018 1:24 PM U y t ff lry f,� t 3ti t e a5'Y '4un. t ni 0! SA �::f sr s.Ms b 1t w f�11 i i;Yi t) k l ♦ , t y:� ( 1 A§i � I T It No, t'§ M v s L i k f 1 ,try rt »J Fc y ',�t4:' `) ♦ �t� i 7Y+js ° i 3� Gt,t'ti. F 2♦.at ��.y ` ♦ j y .:t r 4+;fit y � + EV Win �; xy Y 4 If♦'L ' jY � ,'� 1 �1 � �� * Y4 I -0 - �..4� by �Y•' 9� i TOWN OF SOUTH WINDSOR INSPECTION REPORT PERMIT NO.: CONTRACTOR: A'l I �� C_4VAon hoC, LOCATION: J,5 �'IcfC � dS .J TYPE OF WORK: n l DATE INSP NEEDED: DATE INSP: I INSPECTED BY: r a b WORK IN PROGRESS: 04` �' The c h 11 SEPTIC TANK/PUMPED, SMASHED, FILLED WITNESSED [I YES ❑ NO AS-BUILT: INPUT: C VY\ - DATE: I 0 W/2007 Town of South Windsor INPSECTION REPORT 07 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: Ac� Lot # Street No. 9freet Name Premises owned by: e . Name of Firm: f�T��l`c � � �, Phone: �� y 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 l/ �L//\ �V / ✓�Connection will be made with �� ✓/ Existing Water Supply: Public Water Well Proposed Start Date �° Estimated time for completion �� ��,tz 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 _ � ,Z2c-c,i' the holder of Drain Layer's License No. 02 5�V 5 5° -,/. 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. PLEASE NOTE: IF A SANITARY SEWER LATERAL IS WITHIN 75 FEET OF A WELL IT MUST BE AIR TESTED Sign : Print Name: Licensed Drain La Date: Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT REVISION 3/2016.doc TOWN OF SOUTH WINDSOR SANITARY SEWER LATERAL FIELD LOCATION DATE OF CONSTRUCTION: � � BUILDING ADDRESS JJ STREET : TLC l SUBDIVISION: s NORTH ARROW �L A—V� I 7 f t I E fi i IIA I I 517ALz+ CON TRACTOR (PRINT) NAME OF CONT S SUPERVISOR (PRINT) r 44 SCE ADDRESS. SIG RE , 'li, j C' 16 DATE TOWN STATE ZIP INSPECTED BY TOWN 4� " DATE TELEPHONE NUMBER WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER TOWN OF SOUTH WINDSOR SANITARY SEWER. LATERAL FIELD LOCATION DATE OF CONSTRUCTION: BUILDING ADDRESS STREET SUBDIVISION: LA-�Wl'. cfs NORTH ARROW 19 fl � � I Slew CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPERVISOR (PRINT) STREET ADDRESS SIGNATURE -IS" C i o o _., - - __,l_z1-w;�51-lul TOWN STATE ZIP INSPECTED BY TOWN r i3bo - �S"i-y231 _ DATE TELEPHONE NUMBER WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER