HomeMy WebLinkAboutDrain Layers Permits 330 Governors highw 1400026 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 07/21/2014Plv
GIS ID: 36900330 "x FEE: 60.00
MUMS APPLICATION# 201400992 n � x �� EXPIRATION DATE: 08/20/2014
APPLICANT � k`tIN
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NAME: JAMES THROWE D q ADD Sf ,. 31GVERNORS HIGHWAY
ADDRESS: 97 RIVERSIDE DRIE �� �F ? NE� ' ` LCTIO-METHODS INC
VERNON ROCKVIIL Q6Q66 4=�3
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_ 3 b MERNORS HWY
�,SHoWINDSOR,CT 06074
PHONE 860-28 0� 5
WORK DESCRIPTION: REPAIR} 7
THE DRAIN LAYER ASSIGNED TO THI F�tIIT�sIAS AE �IsTD'YIC'ItiISSUIy$Y�., •.d STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SETATTs,ACHED NI7�TIpI'TS1�` L�ORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDS, L o8la REQU It MEN�nS, D ATTACHED CONDITIONS.
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ISSUED BY D TE MPECTED INSPECTED BY
7/21/2014 2:52 PM
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: I LI 0006 CONTRACTOR: was �o � vAns
LOCATION: _33 D 6- o ✓{'`r yiors 14-w �!
TYPE OF WORK: 0_o a I e- Se we 2
DATE INSP NEEDED: DATE INSP: ` '
INSPECTED BY: I110
WORK IN
PROGRESS: b 4,-m I 57" aj �� ��� 3,5 re®le-ced a
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SEPTIC TANK PU ED, SMASHED, FILLED gZZA WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: DATE: `
S/2014 Town of South Windsor INPSECTION REPORT 14
Perm J 1 / Cf 000 r\16
APPLICATION FOR DRAIN LAYER PERMIT
1 0101' 00 q1 TOWN OF SOUTH WINDSOR
1540 SULLIVAN AVENUE
PUBLIC WORKS DEPARTMENT
TOWN HALL
SOUTH WINDSOR, CT
FEE $60.00
Location of proposed work: 330 Lot #
Street No. Street Naine
Premises owned by: — Jr 1�
Name of Firm: S �� ;ro Phone:
Address of Firm:
TYPE OF WORK:
Lay House Drain ; Repair,House Dram
Lay Main ; Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with
Existing Water Supply: Public Water Well
Proposed Start Date .a J ti Estimated time for completion L 1 I
ALL WORK TO BE IN ACCORDANCE Wll ,TOWN OF SOUTH WINDSOR STANDARDS,
ALL OSHA.REQUIREMENTS AND CONDITIONS ATTACHED TO THE PERMIT
t, Permit is to be issued to }�e, _� �a ._ the holder of Drain
Layer's License No, � b 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.
PLEASE NOTE:
CBYD No U/' IFA SAN. ARYSEWER LATERAL
IS WITHIN75FEET OFA WELL
IT MUST BEAT TESTED
Signed Print Name:
Licensed Drain Layer
Date: 1_ J J
Standard Forms\Perrnit4
PPtICATION FOR DRAIN LAYERS PERM1T.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: i 1"
BUILDING ADDRESS : o er o
STREET
SUBDIVISION:
NORTH ARROW
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110 l5 5ewer y-sepla c, Jim- of
CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPERVISOR (PRINT)
,5l a lvev51®le, nr
STREET ADDRESS SIGNATURE
Vernail 7 as ATE
TOWN STATE ZIP INSPECTED BY TOWN
DATE
TELEPHONE NUMBER
WHITE — TOWN PINK — CONTRACTOR YELLOW — CONSULTING ENGINEER / DEVELOPER