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HomeMy WebLinkAboutDrain Layers Permits 290 Brookfield Stre (2) 1900005 TOWN OF SOUTH WINDSOR, CT PERMIT NUMBER DRAIN LAYER PERMIT DATE: 01/04/2019 GIS ID: 14700290 FEE: 80.00 MUNIS APPLICATION# 201900016 EXPIRATION DATE: 02/03/2019 APPLICANT LOCATION NAME: WASTEWATER SERVICES/DBA SKIPS ADDRESS: 290 BRDOKFIELD STREET ADDRESS: 21 COURTNEY DRIVE ©WI,ER: ZAKEWICZ JOSEPH A&DONNA R 290 BROOKFIELD ST ELLINGTON,CT 06029` PHONE WORK DESCRIPTION: NEW SEWS CONNECTI6N THE DRAIN LAYER ASSIGNED TO THIS PERMIT HAS A VALID LICENSE ISSUER 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 REQUIREME.NTS,AND THE ATTACHED CONDITIONS. /LPL . �7 t ISSUED BY DATE INSPECTED INSPECTED BY 1/4/2019 2:25 PM TOWN OF SOUTH WlNDSOR-INSPECTION REPORT PERMIT NO.:-j WMS CONTRACTOR: �I S LOCATION: TYPE OF WORK: ,� DATE INSP NEEDED: DATE INSP: / 7h INSPECTED WORK IN PROGRESS: vc S�. ' SEPTIC TANK PUMPED,SMASHED, FILLED WITNESSED [J N0 AS-BUILT,:"- INPUT: LVV\-- DATE: *In6 fibrms 2U4Thm ofStt W SON REt'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: 22 O Lot # Street No. Street Name Premises owned by: Jo f *_ .Doa,u A Z Aqke C z_ Name of Firm: -2SLOOS N#57 6,J gT;rt1L- Phone: 6 f-23 3 2— Address of Firm: 7-1, CoU277vc y 2 4 t-' riG�7 AJ 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 V` &-�5rz 3 Existing Water Supply: Public Water Well Proposed Start Date TB D 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 Gv A i the holder of Drain Layer's License No. b z c, 7 7 z � Only holders of P-i, 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. 70,15 r00 Zi S 3 PLEASE NOTE: IF A SANITARY SEWER LATERAL IS WITHIN 75 FEET OF A WELL IT MUST BE.AIR TESTED . Signed: Print Name: A/ 7MP'4195 IV g.0���Z Lic6nsed Drain Layer Date: Standcird farms\PermitsVfUCATM FOR DRAIN LAYERS PERMIT REVISION 3/2018.doc TOWN OF SOUTH WINDSOR SANITARY SEWER LATERAL FIELD LOCATION DATE OF CONSTRUCTION: 7 0` 9 BUILDING ADDRESS : Q q b STREET : 6 --o c N F-T--6-- S r fi SUBDIVISION: NORTH ARROW : _ f 1 i - -- --I 1 - _ _. I t--+---i +-- 1 vir Ags ' i f I ' 1_i t CONTRACTOR (PRINT) , NAME OF CONTRACTOR'S SUPERVISOR (PRINT) STREET ADDRESS SIGNATURE DATE TOWN STATE ZIP INSPECTED BY TOWN DATE TELEPHONE NUMBER WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER