HomeMy WebLinkAboutDrain Layers Permits 175 Pepin Place (2) DATE: 05/09/2017 FEE; 0.00
GIS ID:70700175 EXPIRATION DATE: 06/08/2017
MUNIS APPLICATION# 201700497 2` ak
APPLICANT LOCATION
NAME: ATLANTIC EXCAVATION INC ADDRESS 1?5 PIPIN PLACE
ADDRESS: 363 PARUM ROAD `y QWNR M UILDING CO INC
D
COLCHESTER,CT 064 110 BIt�?OK STREET
TO RIIGTON,CT 06790
`y
PHONE
WORK DESCRIPTION: SEWERSCQCTIOV BUID1NCr.1' u0I71'I V1�*T?S`�R,WOODS
171 1757I83
THE DRAIN LAYER ASSIGNED TO THMI EI IT HA5 A U Ar TD L'10ENSE ISSUED B 'THE STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FOR 1T;T.HE ATTAC D`,C�NDITIQItT ' 1 4?+ORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDDS`,CAI l OSHA REQUIREMENTS,t11II)T #E ATTACHED CONDITIONS.
INSPECTED BY
ISSUED BY DATE INSPECTED
5/9/2017 9:25 AM
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO:: CONTRACTOR:
LOCATION. Ill.
TYPE OF WORK; �n mac' i
DATE INSP NEEDED: DATE INSP.• �G
INSPECTED BY:
WORK IN
PROGRESS: ��c. -Soil. i CK. w, 1,.k
J
� SC 4�i LSJ (b7 i�✓I Uc Trl� 'ves
SEPTIC TANK PUMPEDi SMASHED,FILLED WITNESSED ❑YES ❑NO
AS-BUILT:_ •�
INPUT: DAME:
i UWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $60.00
176-
Location of P p ro osed work m�7 �`���' �%� ��� Lot #
, ,
Street No. Street Name
Premises owned by: 7
Name of Firm: 4 r� 0 -r A,e Phone: Wo 31
Address of Firm:
TYPE OF WORK:
Lay House Drain ; Repair House Drain ;
Lay Main ; Lay Lateral for Commercial/Industrial
Building A-� of acres
Connection will be made with 69- '-*/2ye. __,R'p, 57179 3`5
Existing Water Supply: Public Water �� Well
Proposed Start Date ,S 7 Estimated time for completion •�- �e
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 a the holder of Drain .
Layer's License No. cs(0 c 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/ZZ f0— S PLEASE NOTE:
IF A SANITARY SEWER LATERAL
IS WITHIN 75 FEET OF A WELL
IT MUST BE AIR TESTED
Cinna�� Print Narne! 21 'T �"'o
DATE OF CONSTRUCTION: _ - 17
BUILDING ADDRESS 1-7l 176- l7q, E 3 L$7 t�i - i�e iplaCe,
STREET
SUBDIVISION: 1 hs
03
NORTH ARROW �a� (Z`6 (,v� iZa (,�r
7 17Y 1163 l'W 7 (cf l
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CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPERV (PRINT)
no Tc--su&N t -
STREET ADDRESS / NfWTIAE
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