HomeMy WebLinkAboutDrain Layers Permits 191 Pepin Place (2) 1700018 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 05/09/2017jA
GIS ID:70700191 i FEE: 0.00
MUNIS APPLICATION# 201700502 EXPIRATION DATE: 06/08/2017
APPLICANT
LOCATION.
NAME: ATLANTIC EXCAVATION INC ADDRE3 '10-PI PIN PLACE
ADDRESS: 363 PARUM ROAD ff
' : OWNER 8 1VI BUILDING CO INC
COLCHESTER,CT Q6`�415 "J 110 BQOK STREET
TORRINGTON,CT 06790
PHONE
WORK DESCRIPTION: SEWERk1Co. DS
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THE DRAIN LAYER ASSIGNED TO THI PEr1�4IIT,HAS A VA1 17 LI El*�SE ISSULII B IHI cSTATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FOR, TT 1N�IIE TACIIEI�`c. .1" IpI S'•' I L WORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDRD ,ALL OSII1112EQUTREMENTS,A6p TE ATTACHED CONDITIONS.
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ISSUED BY DATE INSPECTED INSPECTED BY
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NOW CONTRACTOR:
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OCATION.
TYPE OF WORK:
DATE INSP NEEDED: DATE INSP:—. La r,,
INSPECTED BY:
WORK IN
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SEPTIC TANK.PUMPEPiSMASHEb,FILLED WITNESSED ❑YES ❑NO
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APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $60.00
75J
Location of proposed work 1 f3 'W 7 Lot #
Street No. 5zr et Name
Premises owned by:. �Z s
Name of Firm: :Zc Phone: Wo -,e,3 -1170
Address of Firm: ����.�-� C 4 T�
TYPE OF WORK:
Lay House Drain ; Repair House Drain ;
Lay Main ; Lay Lateral.for Commercial/Industrial
Building of acres
Connection will be made with t:�- '
Existing Water Supply: Public Water Well
Proposed Start Date x � 7 Estimated time for completion �� a
ALL WORK TO BE IN ACCORDANCE WITH TOWN OF SOUTH WINDSOR STANDARDS,
ALL OSHA REQUIREMENTS AND CONDITIONS ATTACHED TO THE PERMIT
Permit is to be issued to d bV the holder of Drain
Layer's License No. ,t—�s.n— �' Only ho.ders of P-1. P-7 or W-9 licenses
will be issued a permit. PERMIT WILL EXPIRE THIRTY(30) DAYS AFTER
DATE OF ISSUANCE. The undersigned Drain Layer hereby agrees to all the terms
and conditions set forth in the permit and attached thereto. Applicant has received
Town Street Excavation Permit No. and/or ConnDOT Permit No.
CBYD No. �OnI71 0 ���45_ _. PLEASE NOTE:
IF A SANITARY SEWER LATERAL
IS WITHIN 75 FEET OF A WELL
IT MUST BE AIR TESTED
Signe Print Name:.
Licensed Drai�er
Date: c
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: �� " 17
BUILDING ADDRESS 1-71, 176-i [7q, IK3 , 1�7, l4 t
STREET : pelvic\ TLLCI
SUBDIVISION:
NORTH ARROW tsv i2$ �WS czc
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CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPERV (PRINT)
6
STREET ADDRESS � E
DATE
TOWN STATE ZIP INSPECTED BY TOWN
�66 - - ON DATE
TELEPHONE NUMBER
WHITE — TOWN PINK — CONTRACTOR YELLOW — CONSULTING ENGINEER / DEVELOPER