HomeMy WebLinkAboutDrain Layers Permits 171 Pepin Place (2) 1700013 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
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DATE: 05/09/2017 t;
GIS ID:70700171 f' h: FEE: 60.00
MUNIS APPLICATION# 201700496 EXPIRATION DATE: 06/08/2017
LOCATION
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APPLICATid ti°``
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NAME: ATLANTIC EXCAVATION INC ADDRE �YTPE IN PLACE
ADDRESS: 363 PARUM ROAD $UILDING CO INC
COLCHESTER,CT 06415 110`B QOK STREET
" Ib �GTON,CT 06790
PHONE i s
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WORK DESCRIPTION: SEWER ' ,WDSDR WOODS.
171 175 I,791$3�18711 x ` n
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THE DRAIN LAYER ASSIGNED TO THIS I'ERIrtIIT IIAS Arv.4LTD LIGEIS> ISSUED BY TIYSTATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FOR =ICI T1Ijt�TTFACp`COIDTTIQN3° tI L VORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDARDS ALI,O$HA'REQUIIIEMEIS,ATD°IIE ATTACHED CONDITIONS.
ISSUED BY DATE INSPECTED INSPECTED BY
5/9/2017 9:14 AM
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO,.: CONTRACMR:
19
N:LOCATI i � 7s 9 . 'd
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TYPE OF WORK: 1 -Q f<!%fi
DATE INSP NEEDED: DATE INSP:
INSPECTED BY: 62 '
WORK IN
PROGRESS:. `T� ;� >�►sdl: .� L,"' c. sir_ ;,rku �.
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SEPTIC TANK PUMPED,SMASH9D,FILLED WITNESSED ❑YES ❑NO
AS-BUILT: � •�,� •
INPUT. DATE:
S/mollov,%rms M14 Town of South Windsor Mps@G?dQliCtt p&r 14 _
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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
1 e � /� Lot #
Location of proposed work °f�, / � �}�' ,ti
Street No. Street Name
Premises owned by: 7L ca.n
Name of Firm:_-zgY2��7r� ,-��a�r _,�.��,_ Phone: Sco 3l-//70
Address of Firm: .u.►� � C� t� C r'C� f
TYPE OF WORK:
Lay House Drain ; Repair House Drain ;
Lay Main ; Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with _ ' /2i:JC 22,2
Existing Water Supply: Public Water Well
Proposed Start Date S 8 Estimated time for completion is ?
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 ay the holder of Drain
Layer's License No. , �t"cso 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. �aiZZ57o Bays PLEASE NOTE:
IF A SANITARY SEWER LATERAL
IS WITHIN 75 FEET OF A WELL
IT MUST BE AIR TESTED
Signe Print Name:_,.Ac-,S
Licensed Drain yer
Date: c
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: f5 - (a - 17
BUILDING ADDRESS 121 l7S [7�t, 1K3 1g7; t�i
STREET
SUBDIVISION:
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CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SAPERV (PRINT)
STREET ADDRESSDATE
TOWN STATE ZIP INSPECTED BY TOWN
Ub - , a DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER