HomeMy WebLinkAboutDrain Layers Permits 50 Andrews Way (12) 1600003 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 0I/06/2016
GIS ID: 03200050 FEE: 60.00
MUNIS APPLICATION# 201600017 r A EXPIRATION DATE: 02/05/2016
APPLICANT 5 LOCATION
NAME: BUTLER COMPANY, ADDREbb :.)(I ANDREWS WAY
ADDRESS: 848 MARSHALL PH L1 S ROAD OWNER .OUTA WINDSOR DEVELOPERS LLC
WINDSOR,CT 06045 26 IVIAI&STREET SUITE 100A
CHA`I, AM,N7 07928
PHONE 860-68i 9024
WORK DESCRIPTION: NEW SEER 11 CONNECTION BUTL ING 3`UNI „301 3 2
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THE DRAIN LAYER ASSIGNED TO THISPE (IIT HnS A VAT.IDI,TCEN,�E ISSUED B T IV,STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORTH 1 TI .ATTAHED`GQDTTI(JNS' AS�L 1?bRK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDARDS AL1u OSHA REQUIREMENTS,ANp THE ATTACHED CONDITIONS.
ISSUED BY DATE INSPECTED INSPECTED BY
1/6/2016 12:40 PM
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: I6 0000--3 CONTRACTOR:
LOCATION: To tj n O ) -3 �.-
TYPE OF WORK: w ►�
DATE INSP NEEDED, DATE INSP: jrlj 2/14,
INSPECTED BY: D
WORK IN
PROGRESS: g, G >~ h s W4- G ''' r^arc- slt'R- -4.y .d j'M H
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SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑YES ❑ NO
AS-BUILT:
INPUT: C,� - ~- DATE:
S/molloy/forms 2014 Town of South Windsor INPSEMON REPORT 14
APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
1540 SULLIVAN AVENUE
PUBLIC WORKS DEPARTMENT
TOWN HALL
SOUTH WINDSOR, Cr
FEE$60.00
.Location of �work: 4 -- Z Z proposed Lo
Street No. Street Name
Premises owned by: n64__n WAe
Name of Firm: Phone:
Address of Firm: , "// &L
TYPE OF WORK:
Lay House Drain..,; Repair House Drain-
Lay Main ; Lay Lateral for Commerdal/Industrial
Building of acres
d
• Connection will be made with
adsting Water Supply: Public Water Well
Proposed Start Dat 5 Estimated time for completion
ALL WORK TO BE IN ACCORDANCE WLi7•l.TOWN OF SOUTH WINDSOR STANDARDS,
ALL OSHA REQUIREMENTS CONDTRONS ATTACHED TO THE PERMIT
Permit Is to be issued '�� Q �^-L the holder of Drain
Layer's License No. AZI b�27f 3 ?-. my 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.
PLEASE NOTE:
CBYD No. rFA SA NI TARYS"MER-LATERAL
IS WITffIN75FEET 4FA WELL
IT M17Z EN TESTED
Signed: Print Name:
'nsed Drain Layer
Date: G
Stawaw Forms\Permits\APPLICAn0N FOR DRAIN LAYERS PERMIT.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS
STREET
SUBDIVISION: '
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NORTH ARROW
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CONTRACTOR (PRINT) NAME 0 CONTRACTOR'S SUPERVISOR (PRINT)
_ ._
STREET ADD ESS SIGNATURE
DATE
TOWN STATE ZIP INSPECTED BY TOWN
/Ky A�l- E,)Z DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER