HomeMy WebLinkAboutDrain Layers Permits 30 Clark Street (2) 1600056 TOWN OF SOUTH WINDSOR, CT
PEkMYT NUMBER DRAIN LAYER PERMIT
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DATE: 10/05/2016
GIS ID:20400030
' 60.00
MUNIS APPLICATION 0 201601455 FEE:
EXPIRATION DATE: 11/04/2016
APPLICANT _ r LOCATION
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NAME: SIMSCROFT ECHO h'. RMSA" ADD STREET
ADDRESS: P 0 BOX 581 n; RIN0 ROBERT&
SIMSBURY,CT 060�'7(I` z �4 r a ze` 4QO�CIIPEL ROAD#3F
AP
t S,S OUTH WINDSOR, CT 06074
PHONE 860-65 L 0231$
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WORK DESCRIPTION: DEMOI S-IjNQ.-
THE DRAIN LAYER ASSIGNED TO THIS PE2MI�I� TFS t��VL IA T�X�ENSE�5`Si�ED�BS���HWSTATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORIH:,IN THFA ,YiiED` (�? I1fE1`1�OI�I ' , ,� V RK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDAtDS ALT.�ISHA'RI;�TxR1;MEi7 $,tD T ATTACHED CONDITIONS.
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ISSUED BY DATE NSPECTED . INSPECTED BY
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TOWN OF SOUTH WINDSOR INSPEcnoN REPORT
PERMIT NO;: 16 QQQ L CONTRACTOR:
LOCATICIN: n S
TYPE OF WORK: McmalksbiL14
DATE INSP NEEDED: DATE INSP:
INSPECTED BY'.-
WORK IN
PROGRESS: . 5 r, '1
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SEPTIC TANK PUMPED, ASH9D,FILLED WITNESSED ❑YES ❑ NO
AS-BUILT:
INPUT: V� DATE!
S/molloy/forms 2014 Town of South Windsor I(VSWMN WOU 14
APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
1540 SULLIVAN AVENUE
PUBLIC WORKS DEPARTMENT
TOWN HALL
SOUTH WINDSOR,CT
FEE $60.00
Location of proposed work: c) CL;.�✓ Lot #
- Street No. Street Name
'Premises owned by:
Name of Firm:- Phone o - 55
Address of Firm: i Zui _ l
TYPE OF WORK:
Lay House Drain_ Repair House Drain. :
Lay Main : Lay Lateral for Commercial/Industrial
n.
Building of acres
Connection will be made with
Existing Water Supply: Public Water Well
Proposed Start Date• 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
k Permit is to be issued to the holder of Drain
{3 ` Layer's License.No. L- ,Q L_, �-
2���.� � •. Only holders of Pd1, P-7. or 1N 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 U go i �k f TFA SANITARYSBWER-LArERAL
IS WJTHrN75FEET OFA WELL
lT AlUST SEAR rESTED
signed: , lC �- G n'
Print Name, _ t .
Licensed Drain Layer
Standard Forms\Permbt APPLIC-.TION FOR DRAIN LAYERS PERmrr doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: ' `' 90/ lle
BUILDING ADDRESS
STREET
SUBDIVISION:
NORTH ARROW
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CONTRACTOR (PRINT) NAME OF CONT TOR'S SUPERVISOR (PRINT)
STREET ADDRESS SIGNATUR
TOWN 13 STATE ZIP INSPECTED BY TOWN
G
J b' d - �; ( T- d J C DATE
TELEPHONE NUMBER
WHITE - TOWN PINK -- CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER