HomeMy WebLinkAboutDrain Layers Permits 54 Longmeadow Drive (2) 1800099 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 12/10/2018
GIS ID: 54670054 FEE: 80.00
MUNIS APPLICATION# 201802381 EXPIRATION DATE: 01/09/2019
APPLICANT LOCATION
NAME: SSC CONSTRUCTION LLC ADDRESS: 54 LONGMEADOW DRIVE
ADDRESS: 1700 SAYBROOK ROAD OWNER: TOLL LAND XVIII LIMITED PARTNERSHIP
42 OLD RIDGEBURY ROAD
MIDDLETOWN,CT 06457
PHONE
WORK DESCRIPTION: NEW SEWER;,CONNECTION
THE DRAIN LAYER ASSIGNED TO THIS PERMIT HAS A VALLID 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.
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LOCATION:
TYPE OF WORK;.
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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; S� �'Iq�l�aclati/ Lot # 3 7
Street No. Street Name
Premises owned by: ( v t( 1:�rcic- -�Pn e-
Name of Phone: i6O•ZsCl-23 ' Y
Address of Firm: 17cly SGyb � ✓I� h.,;✓�cc}d,,;A.� <<
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 6� sn2
Existing Water Supply: Public Water_ Well
Proposed Start Date 12- w Estimated time for completion / 2- fa . r�
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. Rm oznrij 1--► -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. Zo f B-So G,3 1-(1 6 PLEASE NOTE:
IF A SANITARY SEWER LATERAL
IS WITHIN 75 FEET OF A WELL
- IT MUST BE-AIR TESTED .
Signed: Print Name: Sa(VCAV,,L
Licensed Drain Layer
Date: r Z. 10
Standard Forms\p mits\A MCATION FOR DRAIN LAYERS PERMIT REVISION 3/2018.doc
TOWN OF SOUTH WINDSOR
SANITARY
SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: ' /® 8
BUILDING ADDRESS Sy �`' t 37
STREET
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CONTRACTOR (PRINT)
NAME 0 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