HomeMy WebLinkAboutDrain Layers Permit 0767 Avery Street 1900001 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 01/02/2019
GIS ID: 06300767 FEE: 80.00
MUNIS APPLICATION# 201900001 EXPIRATION DATE: 02/01/2019
APPLICANT LOCATION
NAME: JAMES THROWE DBA ADDRESS: 767 AVERY STREET
ADDRESS: 1330 MAIN STREET OWNER; COFFEY STEVEN P
767 AVERY STREET
SOUTH WINDSOR,CT06674
PHONE 860-289-0095
WORK DESCRIPTION: NEW SEWS CONNECTION
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
1/2/2019 9:08 AM
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: ./900 OQ f CONTRACTOR:
LOCATION: �►1r�12 v
TYPE OF WORK:
DATE INSP NEEDED.: DAIS INSP: `� fg
INSPECTED BY.-_ nU
WORK IN
PROGRESS: w e `.
SEPTIC TANK PUMPED, iED, FILLED WITNESSED ❑YE5 F Na
AS-BUILT:
INPUT: DATE: L.�
**toy 2.4 TM of South V INPSECRON 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: 7�-7 Lot #
Street No. Street Name
Premises owned by: L (4
Name of Firm: nn r C -1 , Phone: o 2im 60 TS
Address of Firm: 1 ,339 W al.
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 `� �, � r.�► � c�i��
Existing Water Supply: Public Water Wel
Proposed Start Date L 4) 1c 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 uMc Iry ov� the holder of Drain
Layer's License No. aU�b3S' Only holders of P-11 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. JO/9- V V PLEASE NOTE:
IF A SANITARY SEWER LATERAL
IS WITHIN 75 FEET OF A WELL
IT MUST BE-AIR TESTED .
Signed: Print Name:
Licensed Drain Layer
Date:
standard Forms\Pwnft\APMCATM FOR DRAIN LAYERS PERMIT REVISION 3/2018.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER -LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: C - 11 -
BUILDING ADDRESS 76 7
STREET : AVF Y �
SUBDIVISION:
NORTH ARROW
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CONTRACTOR (PRINT) NAME OFCONTfACTOR SUBRVISOR (PRINT)
STREET ADDRESS SIGNA RE
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�rV DATE
TOWN STATE ZIP INSPECTED BY TOWN
DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER