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HomeMy WebLinkAboutDrain Layers Permits 151 Oakland Road 1700005 TOWN OF SOUTH WINDSOR, CT PERMIT NUMBER DRAIN LAYER PERMIT DATE: 01/24/2017 GIS ID:65700151 S s` MUNIS APPLICATION# 201700063 FEE: 60.00 �� t� t & x EXPIRATION DATE: 02/23/2017 4a .• r y5r (S �� � �t.} APPLICANT LOCATION NAME: ASHE CONSTRUCTXNZ LC ADDRESS LAND ROAD ADDRESS: 17 GRAMAR AVENi1Er .' OWNER SI LE MILDRED S.LU PROSPECT,CT 067�2 151"' AND ROAD r54ggke �SOrTTkI WINDSOR,CT 06074 PHONE Sj. x1L Y F r l E YET S4 Y WORK DESCRIPTION: DISCONNRCT S7a�'ER PAST'OF�3ARRhi'F?FATG�Il r x fir THE DRAIN LAYER ASSIGNED TO THI3,4VEI HT IIAS A AI: LI 1 S rSSUED 4 I1;="STATE AND HEREBY AGREES TO ALL THE TERMS AND CONDITIONS SET FORT IN T IE.ATT, I H �}`%O &',IN' r 1 LL ORK SHALL BE IN ACCORDANCE WITH THE TOWN OF SOUTH WINDSOR STANDAR�3 A L bSHA RE i1HtEMI;I :TS,ADD T ATTACHED CONDITIONS. it ISSUED BY DATE INSPECTED INSPECTED BY 1/24/2017 2:05 PM � b tf j1Sagp E4 * 4 4 r Ottal? �` 1 k #", k h� S syt"4 .�1`s l� � 'S5� l'� s�a kz.""„M i;. YSB Sa �� '� y � Tye �,r•4 rF ,.�. yQ ' jo • S , ^L i y k � a'` ?4 r� TOWN OF SOUTH WIN©SOR INSPECTION REPORT PERMIT Na: CONTRACTOR: LOCATION: TYPE OF WORK: �1��G : �y✓' DATE INSP NEEDED: DATE INSP: INSPECTED BY: _ WORK IN PROGRESS:. 4 V A /' SEPTIC TANK PUMPED,SMASHED, FILLED WITNESSED ❑YES ❑NO AS-BUILT: DATE:.. S/molioylbms 2014 Town of SaA Windsor INPSECQ =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:-1 i� 0,11 Lot # Street No. Street Name Premises owned by: Ad -r Jro -r,,-7 s 3 0 r-'.+10" Name of Firm: As N C c:o ti s 4tu cA v o^ i c- c- Phone: zo- oc, z.3-z/ Address of Firm: �� e cc 17 TYPE OF WORK: S eAAD(P-r— -C` 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 the holder of Drain Layer's License No. P-rl -oo za P q 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. o►Q o 5 o o ?o ff PLEASE NOTE: IF A SANITARY SEWER LATERAL IS WITHIN 75 FEET OF A WELL / IT MUST BE AIR TESTED Signe ` Print Name: TQ g s F_ !4s i4 Lr Licens rain Layer Date: / - / !3— /7 Standard Forms\Parmits\APPLICATION FOR DRAIN LAYERS PERMIT.doc TOWN OF SOUTH WINDSOR SANITARY SEWER LATERAL-- FIELD LOCATION DATE OF CONSTRUCTION: J. BUILDING ADDRESS : STREET : 19 0 A J:L.L-A- .R CD SUBDIVISION: NORTH ARROW _- r I I � 1 CONTRACTOR (PRINT) NAME OF TOR'S S PERV OR (PRINT) STREET ADDRESS 5MATURE DATE TOWN STATE ZIP INSPECTED BY TOWN r --� 3 `7 DATE TELEPHONE NUMBER WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER