HomeMy WebLinkAboutDrain Layers Permits 14 Chaponis Way (2) 1600061 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
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DATE: 11/07/2016 �sx,
211411 AS
GIS ID: 18270014 t k T v FEE: 60.00
MUNIS APPLICATION# 201601641 N
Wy 1:1k 1, EXPIRATION DATE: 12/07/2016
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APPLICANT w1l LOCATION
NAME: MANNARINO BUIL ERS ITC ¢DDRESS 14 CH'1PONIS WAY
ADDRESS: 400 CHAPEL ROAI�*3I; IYI�NI�f?►RINO BUILDERS LLC
SOUTH WINDSOR QT bU`74�
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WORK DESCRIPTION: NEW SI ' i N CTIt? 1 arz � A to r ti ..
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THE DRAIN LAYER ASSIGNED TO THI +PEI'pfi4T HAS A�A1v1I7 BISEIr1SESSTTEI 'B I?H STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FOIi IN TEE r�T"TACHED Q+fiD TIQI S' ,MIL WbRK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STAND12 ALL OSHAR�EfUMEIfT 5,,4I4D CLTE ATTACHED CONDITIONS.
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ISSUED BY DATE INSPECTED. INSPECTED BY
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TOWN OF SOUTH WINDSOR INSPEMON REPORT
PERMIT NO:: L6 Q 0lj CONTRACTgw 1*mla lj')0 _ -
LOCAITON: / C AA &0 h) S IA)a,L
-TYPE OF WORK: � E?4� �SC'w�r ` Dee- , 6 ki
DATE INSP NEEDED: DATE INSP:
.INSPECTED BY:
WORK IN
PROGR:�s
SEPTIC TANK PUMPED,SMASHED, FILLED WITNESSED ❑YES ❑NO
AS-BUILT:
INPuT:
S/fnofloy/ftims 2a14 Tom of smth Windsor INPSWWN WORT 14
APPLICATION FOR DRAIN LAYER PERMIT
. TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR CI"
FEE $60.00
Location of proposed work:
d� Lot #
Street No. Street Name
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Premises owned by:
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Name of Firm: Phone: � �
�i �.�2 77
Address-of Firm: d / R - �q
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TYPE OF WORK:
Lay House Drain Repair House Drain
Lay Main . • Lay lateral for Commercial/Industrial .
Building of `acres
Connection will be made with f
E)dsting 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
Layer's License No. the Folder of Drain
will be issued.a Only.holders of P-1, P-7 or W-9 licenses
Permit. PERMIT WILL EXPIRE THIRTY(34)`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.
Signed: G'
Print Name:
Licensed Drain Layer
Date: 6
standard FOFMAPermitsWPUCAPON FOR DRAIN LAYERS PERMT.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: If
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BUILDING ADDRESS 1
STREET
SUBDIVISION:
NORTH ARROW
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CONTRACT (PRINT) NAME gy CONTRACT 'S SUPERVISOR (PRINT)
S EET ADDRESS SIG WA
DATE
TOWN STATE ZIP INSPECTED BY TOWN
- DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER