HomeMy WebLinkAboutDrain Layers Permits 187 Pepin Place (2) 1700017 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 05/09/20I7
GIS ID:70700187 FEE: 0.00
MUNIS APPLICATION# 201700501 kj , r } EXPIRATION DATE: 06/08/2017
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APPLICANT u � LOCATION.
NAME: ATLANTIC EXCAVATIQN INC:'; PEPIN PLACE
ADDRESS: 363 PARUM ROAD : OWNER &M bUILDING CO INC
COLCHESTER,CT f}6415 x 1'10R�}OK STREET
'IQGTON,CT 06790
PHONE ' `
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WORK DESCRIPTION: SEWEW',CONNECTII?N BUIT.DING 19 SOfitJ'1' a;' S0 WOODS
171 175 �,i,79v�1�83'FI 8'111 Q 1 y
THE DRAIN LAYER ASSIGNED TO THI ,PEIMITHt�S A UAT ID LIC1S ISSUEI�B TILE'STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORTIT= THE xiTTACTED`CQ1�IDITI()�TS°..A ALORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STAND DITIONS.
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ISSUED BY DATE INSPECTED INSPECTED BY
5/9/2017 10:14 AM
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TOWN OF SOUTH WINDSOR INSPECI`ION REPORT
PERMIT No. CONTRACTOR:
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LOCATION. rl 1Y
TAPE OF WORK: . va c`I .
DATE INSP NEEDED: DATE INSP. • '� �'
INSPECTED BY:
WORK IN
PROGRESS'
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SEPTIC TANK-PUMPED,5MASH90,FILM WITNESSED ❑YES ❑NO
INPUT: DATE; '
5ftoltoymrms tam Tim of South Windsor mo86C11OmPORT 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: 721 �/JA
Name of Firm: ������� ^�.,6 � ��. Phone: Wo
Address of Firm: ���� � � lc 4-4 (Z-2—cc
TYPE OF WORK:
Lay House Drain ; Repair House Drain ;
Lay Main ; Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with / A
Existing Water Supply: Public Water �� Well
Proposed Start Date Xz4z 7 Estimated time for completion �a
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 ��,�� ,&c i __ the holder of Drain
Layer's License No. _ 4 (n 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. O PLEASE NOTE:
IF A SANITARY SEWER LATERAL
IS WITHIN 75 FEET OF A WELL
IT MUST BE AIR TESTED
Sig ne Print Name:
Licensed Drai5�LAyer
Date: c�
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIF.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: 17
BUILDING ADDRESS ITl 176-il7q. l 3 MOW - i7e i
STREET
SUBDIVISION: �� s
izl L� (-I,? L 4� I'3v La IS J lal'��Z � 0:3
NORTH ARROW °� 6' 117 Ili
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CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPERV (PRINT)
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5TRElET ADDRESS SWOAlM/ E
�� �" C l r "-- DATE
TOWN STATE ZIP INSPECTED BY TOWN
DATE
TELEPHONE NUMBER
WHITE - TOWN PINK -- CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER