HomeMy WebLinkAboutDrain Layers Permits 925/935 Sullivan Av (2) 1300038• TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 11/0412013
GIS ID: 87300925 0' FEE: 60.00
MUNIS APPLICATION# 201301615 rEXPIRATION DATE: 12/04/2013
APPLICANT _ LOCATION ,
NAME: GERBER CONSTRUCT LIVAN AVENUE ,dl
ADDRESS: 1 NUTMEG DRIVE m R I PLACE LLC
ELLINGTON,CT 060 VAN AVENUE
HINDSOR,CT 06074
PHONE 860-875- 6
WORK DESCRIPTION: 925 935 S L S ON SITE
SLEEVE
THE DRAIN LAYER ASSIGNED TO THIS ERM V �< �1 ^'S ATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FOR TT. NS' SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STAND ACHED CONDITIONS.
ISSUED BY DA D INSPECTED BY
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Perr✓,,'f # /300038
APPLICATI41 FOR DRAIN LAZIER PERMIT
TOWN OF SOUTH WINDSOR
1540 SULLIVAN AVENUE
PUBLIC WORKS DEPARTMENT
TOWN HALL
SOUTH WINDSOR,CT
� t FEE$60.00
�Locatlon of proposed work:
Lot#
Street No. Street Name
Premises owned by
Name of Firm: - s YL Phone:
Address of Firm• r 'i
TYPE OF WORK:
Lay House Drain �,; Repair House Drain-
Lay Main _.___; Lay Lateral for Commerdai/Industrial
Building of acres
Connection will be made with 4` lI
Existing Water Supply: Public Water Well
Proposed Start Date 7-7--Ze Estimated time for completion `)f J
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. Only holders of P-1, P-7 or W-9 licenses
will be issued a permit. PERMIT WILL EXPIRE THIRiY(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 Na.
PLEASE NOTE:
CBYD No. IFA SANITARYSEWER LATERAL
IS LVITIYIN75 FEET OF WELL
IT IFfUST wAIR TESTED
Signed: Print Name: .�� .
Licensed Drain Layer
Date:
6- 1 . 00715t
Standard r0rms\Permits\APPUCAn0N FOR QWN LAYERS PERWT.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS
STREET • 5�,�1 �� � n - �`
SUBDIVISION:
NO TH ARROW
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CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPERVISOR PRINT)
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STREET ADDRESS SIGNATURE
DATE
TOWN STATE ZIP INSPECTED BY TOWN
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:
NORTH ARROW
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CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPERVISOR (PRINT)
STREET ADDRESS SIGNATURE
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TOWN STATE ZIP INSPECTED BY TOWN
6 0 ` � DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER