HomeMy WebLinkAboutDrain Layers Permits 6 Chaponis Way (2) -- . ...... .. .. .. ... .. . .
1600069 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 11/14/2016
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GIS ID: 18270006 FEE: 60.00
MUNIS APPLICATION# 201601680n EXPIRATION DATE: 12/14/2016
APPLICANAl 3 w Pr, s LOCATION
NAME: EAGLE EARTHWOIkSER'� l �.DDRE S ` �i6 CHA ONIS WAY
ADDRESS: 101 N MOUNTAIN II 01 NO BUILDERS LLC
CANTON,CT 0601 1 ; v f r.
Y` 4 0 CHAPEL ROAD#3F
SLI`PHWINDSOR, CT 06074
PHONE 860-6A 2027 '
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WORK DESCRIPTION: NEW SsO�NN°ECTCriT'
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THE DRAIN LAYER ASSIGNED TO THIS"-aPEBMIT 1AS�A'ViALID `I 1 SE SSUEI3'$ THIS STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FOlft THE ATTA Ia O 11C�N 'yY-A I RK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WIND.SOR STANDS,ALA OSHA QTIREMEl S,Q 1D'THE ATTACHED CONDITIONS.
ISSUED BY DATE INSPECTED. rNSPE-CMD BY
11/14/2016 2:37 PM
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO:: / 0006 CONTRACTOR;
LOCAMM:
TYPE OF WORK:
DATE INSP NEEDED; DATE INSP:
INSPECTED BY: fb
WORK IN
PROGRESS: f� - ��
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SEPTIC TANK PUMPED,-SMASHED, FILLED WITNESSED ❑YES ❑ NO
AS-BUILT: -
INPUT: ` �`- DATE:
S/mollay/Mirms 2014 Town of South Windsor INPS=ON 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 Namn
Premises owned by: �
Name of Firm: � � '
c. Phone: 9..? P—In,
Address-of Firm: od,o�
TYPE OF WORK:
Lay House Drain_; Repair House Drain
Lay Main .
Lay Lateral'for Commercial/Industrial
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
Permit is to be issued to C4C � q
Layer's License No. the holder of Drain
. 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.
c
Signed: l Print Name: ,r 67 or-, L'q/�
Licensed Drain Layer
Date:
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERmmdoc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: �'�lb
BUILDING ADDRESS _
STREET
SUBDIVISION: c clr� 1 14
NORTH ARROW
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CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPERVISOR (PRINT)
STREET ADDRESS SIGNATURE
Cam- �,_. DATE
TOWN STATE ZIP IN P CTED BY TOWN
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&Z-7 DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER