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Home My WebLink AboutDrain Layers Permits 9999 Clark Street (2) 1600043 TOWN OF SOUTH PERMIT NUMBER W I N D S O R, C I DRAIN LAYER PERMIT DATE: 08/11/2016 GIS ID:20409999 MUNIS APPLICATION# 201601104 4x1 rt FEE: T60. 0 A Arm ti < EXPIRATION DATE: 09/10/20/6 APPLICA 2 NAME: SIMSCROFT ECHO 17ARMS =- LOCATION ADDRESS .; ti STREET ADDRESS; P O BOX 581 SIMSBURY,CT 060�06 SOUTI�ITWINDSOR TOWN OF , 1 dD SttLIVAN AVE PHONE r L` 860-651`b23'1 k t SOITTHtWINDSOR, CT 06074 f A'; ti l tf 4' } WORK DESCRIPTION: NEW StRm MA a THE DQlf RAIN DRAIN LAYER ASSIGNED TO THIS PE MIT #S A VAI.IU LI FSNSE SSUI ID'$KT.Hg?STATE AND HEREBY AGREES TO ALL THE TERMS AND CONDITIONS SET FOR�F�I11�iT'HE�1T�T,�iu�D 1�0]tJb�`TI�Ng:k,,�„I; ` THE TOWN OF SOUTH WINDSOR STAND ` ,AI,L OSHA REQt IREMEH WORK SHALL BE IN ACCORDANCE WITH , DHl ATTACHED CONDITIONS. ISSUED BY 8/11/2016 12:59 PM D TE INSPECTED . INSPECTED BY S x z-k - 'AAl t t; �w S t � k 1 ,VP t .��r TOWN OF SOUTH WINDSOR INSPECTION REPORT PERMIT Na.: 14 CONTRACTOR: LOCATION: I A-a sr-re TYPE OF WORK: DATE INSP NEEDED: DATE INSP: INSPECTED BY: � WORK IN PROGRESS: SEPTIC TANK PUMPED,SMASHED, FILLED WITNESSED ❑YES ❑ NO AS-BUILT.- INPUT: C(� ..... DATE: ' S/i nolloy/forms 2014 Towns-bf South Windsor INPSECriON REPORT 14 APPLICATION FOR DRAIN LAYER PERMIT TOWN OF SOUTH WINDSOR PUBLIC WORKS DEPARTMENT TOWN HALL 1540 SULLIVAN AVENUE SOUTH WINDSOR, CT FEE $60.00 Location of proposed work: - Lot # Street No. Street Name Premises owned by: . Y—; Name of Firm:-�1. Phone:< ea t� --OL31 Address of Firm:. . of c)IO TYPE OF WORK: Lay House Drain ; Repair House Drain ; Lay Main ; Lay Lateral for Commercial/Industrial Building of acres Connection will be made with 1�114, iE_ Existing Water Supply: Public Water Well Proposed Start Date��G;1-sue Estimated time for completion z 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�"n„�_� .G, �� the holder of Drain Layer's License No A.ozz 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. PLEASE NOTE: IF A SANITARY SEWER LATERAL IS WITHIN 75 FEET Of A WELL IT MUST BE AIR TESTED Signed: rint Licensed Drain Layer Date: Standard Forms\Permits\APPLIC1"fTON FOR DRAIN LAYERS PERMIT.doc• •. ,.:.:••'•:' :.% _ ... TOWN OF SOUTH WINDSOR SANITARY SEWER LATERAL FIELD LOCATION DATE OF CONSTRUCTION: +� 0 16 BUILDING ADDRESS STREET : � -o- , tv SUBDIVISION: A NORTH ARROW- t - -�- - - -�-- -dot4 I Mt LI_ . ..... 5c- 5_z� G t1 T_a^{`f rl s CONTRACTOR (PRINT) NAME OF CON C R'S SUPERVISO (PRINT) STREET ADDRESS _ SIGNATURE r ! )` 0 0 DATE TOWN J STATE ZIP INSPECTED BY TOWN _ I- 6!� 665 0 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 -E- SUBDIVISION: ��s'�t � ' �► 1 ) NORTH ARROW �1 j AA ' I _.._ .-.��.�__ E 3 f I �sC2� FA0 ALP^ s �Nv e - h6' --.n 5l� CONTRACTOR (PRINT) NAME OF CO CTOR'S SUPE OR (PRINT) STREET ADDRESS ` SIGNATURE + c- y 60- i --;' ...—�..� ��e ��zz/� DATE TOWN STATE ZIP INSPECTED BY TOWN 0 � U DATE TELEPHONE NUMBER WHITE — TOWN PINK — CONTRACTOR YELLOW — CONSULTING ENGINEER / DEVELOPER I TOWN OF SOUTH WINDSOR SANITARY SEWER LATERAL FIELD LOCATION DATE OF CONSTRUCTION: �� '� pa BUILDING ADDRESS 3 STREET SUBDIVISION: eb ' NORTH ARROW IN - - CONTRACTOR (PRINT) NAME OF CO ORBS SUPERVSOR (P ) STREET ADDRESS SIGNATURE ✓h 6j C, ' 0 6 o ? 0 �. �IL DATE TOWN STATE ZIP INSPECTED BY TOWN 0 DATE TELEPHONE NUMBER WHITE - TOWN PINK - CONTRACTOR YELLOW CONSULTING ENGINEER / DEVELOPER TOWN OF SOUTH WINDSOR SANITARY SEWER LATERAL FIELD LOCATION DATE OF CONSTRUCTION. � o. BUILDING ADDRESS 7 STREET SUBDIVISION: NORTH ARROW 1 q CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPERVISOR (PRIN STREET ADDRESS _ _ SIGNATURE 0,LA `.) DATE TOWN STATE ZIP INSPECTED BY TOWN spa t2 —19 '54 DATE TELEPHONE NUMBER WHITE — TOWN PINK — CONTRACTOR YELLOW — CONSULTING ENGINEER / DEVELOPER TOWN OF SOUTH WINDSOR SANITARY SEWER LATERAL FIELD LOCATION DATE OF CONSTRUCTION: 5,u BUILDING ADDRESS : 5 3�; 5-q t 4 f STREET : SUBDIVISION: ) '`> NORTH ARROW 00, 14 _ - � �1 t✓"��Ica �c=�Q, �A{`✓h,�� ..,.,,.., � t FYI l �-- �Wl � �$'Ifl � I CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPERVISOR (PRIN ri STREET ADDRESS i SIGNATURE 4 �_ -. � ` G DATE TOWN STATE ZIP INSPECTED BY TOWN - �L(� DATE i TELEPHONE NUMBER WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER i TOWN OF SOUTH WINDSOR SANITARY SEWER LATERAL FIELD LOCATION DATE OF CONSTRUCTION: BUILDING ADDRESS ; 71 7 7 STREET 6V 61 SUBDIVISION. � � ��--� 5 NORTH ARROW f � ' 1000I I _ 1 - CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPERVISOR (P Ea STREET ADDRESS SIGNATURE S r 6 0'70 l a lzi,A DATE TOWN STATE ZIP INSPECTED BY TOWN 0� �i $1 �, `° �� DATE - TELEPHONE NUMBER WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER TOWN OF SOUTH WINDSOR SANITARY SEWER LATERAL FIELD LOCATION DATE OF CONSTRUCTION: b6 BUILDING ADDRESS { (on D, J STREET : 96 . ' 4-A Lit SUBDIVISION: G i �` '� NORTH ARROW ; _ - -�-- Y..� . - j 9ft>4 cl CONTRACTOR (PRINT) NAME OF CONT CTOR'S SUPERVISOR (PRINT) g J n E� � r STREET ADDRESS SIGNATU DATE TOWN STATE ZIP INSPECTED BY TOWN DATE TELEPHONE NUMBER WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER