HomeMy WebLinkAboutDrain Layers Permits 30 Clark Street (3) 1700002 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 01/03/201701,
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GIS ID:20400030 `k
F FEE: 60.00
MUMS APPLICATION# 201700005 EXPIRATION DATE: 02/02/2017
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APPLICANT = = r , 5s
LOCATION
NAME: EAGLE EARTHWORK SERy ADDRESS 30LtRK STREET
ADDRESS: 101 N MOUNTAIN RDAT ' OWNER .IV, NNARINO ROBERT&
CANTON,CT 06019 4 4Q0 CirPEL ROAD#3F
s 1 �ySOr1TH WINDSOR,CT 06074
PHONE 860-693,2027 3 ; r "
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WORK DESCRIPTION: NEW SEWER CONTECTICiN �t yf a ' rfii
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THE DRAIN LAYER ASSIGNED TO THISIERI�II�SHt�S A VALI7 LI"I NSIx ISSULIB �THSTATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORS Ei TN THIS ATT IRED G01 I�LTI'ON. ALIw V jRIC SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDARDS EMT- AI ?'TI ATTACHED CONDITIONS.
ISSUED BY DATE INSPECTED INSPEC D BY
1/3/2017 2.28 PM
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO i 7 0&22 CONTRACTOR: f'a %e 2.4y�A we p/
LOCATION: 3 1) cl at V- S -a-1
TYPE OF
DATE INSP NEEDED: DATE INSP: f /?
INSPECTED BY: PaD
WORK IN
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SEPTIC TANK.PUMPED,SMASHED, FILLED WITNESSED ❑YES ❑NO
AS-BUILT: "
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S/molioy/forms 2014 Town or south Windsor INPSECIIQITWOU 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: �2nAo RoY&,!!�
Name of Firm:
n� ��, r Phone:
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Address of Firm:
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 ,q-f Estimated time for completion Y r
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 cEG���� �✓c� the holder of Drain
Layer's License No. 47 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: Print Name:-A `C �t 01�.( U" I �� ��
Licensed Drain Layer
Date: 7--�- J
2
standard Forms\Permits\APPLICA-a0N FOR DRAIN LAYERS PERMIT.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: T
BUILDING ADDRESS o „ .
STREET : .
SUBDIVISION:
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SYRaEET ADDRESS ��p �I NA E
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TOWN STATE ZIP INSPECTED BY TOWN
a�' DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER