HomeMy WebLinkAboutDrain Layers Permits 179 Pepin Place (2) 1700015 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 05/09/2017
GIS ID: 70700179 FEE: 0.00
MUNIS APPLICATION# 201700498 , EXPIRATION DATE: 05/08/2017
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APPLICANIT LOCATION
NAME: ATLANTIC EXCAVATION INC = ADDRI{SS 179`PEPIN PLACE
ADDRESS: 363 PARUM ROAD k OWNER T&M$UILDING CO INC
COLCHESTER,CT 06415 110ROOK STREET
T(aIZRI1�7GTON,CT 06790
PHONE k
WORK DESCRIPTION: SEWER COI�INE�TZQN BUILDING 19 SOTHViDSQ3R FOODS
171 175 1,79 f83N 87
THE BRAIN LAYER ASSIGNED TO THISRPEIMIT,IIAS A VALID I> ENSESSUED B I'HU$STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FOR`II IN THE ATTACHED GHQ 1-0 15T ONS',ALL WtJRK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDARDS,Ai.L OSHA RI QTIfIMMEI I:TS AND TL ATTACHED CONDITIONS.
ISSUED BY DATE INSPECTED INSPECTED BY
5/9/2017 9:33 AM
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO:: CONTRACTQR: - .
LOCATION: I'll. r 9 '# ��' � 1
9
TYPE OF WOR ' l 12 PPLEC- . ,
DATE INSP NEEDED: DATE
IMPECTED BY:
WORK 14
PROGRESS' .AU,,4�v�
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SEPTIC TANK.PUMPED,SMASHgDr FILLED MESSED ❑YES ❑NO
AS-BUILT•
INPUT: PAM "
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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
9 15 ��
Location of proposed work %f 7 `j Lot # v
Street No. Street Name
Premises owned by:. m ,S
Name of Firm: 0 r,c .-��6 ,�-r sZAc. Phone: Wo
Address of Firm:
TYPE OF WORK:
Lay House Drain ; Repair House Drain ;
Lay Main ; Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with
Existing Water Supply: Public Water Well
Proposed Start Date ,� � 7 Estimated time for completion S I!?
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 <�fl'.l Z ,� �� ►� the holder of Drain
Layer's License No. ,cb-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. 7/3D fa yS PLEASE NOTE:
IF A SANITARY SEWER LATERAL
IS WITHIN 75 FEET OF A WELL
IT MUST BE AIR TESTED
Signe Print Name: �S
Licensed Drain yer
Date:
Standard Porms\Permits\APPLICATION FOR DRAIN LAYERS PERWT.doc L
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: �� 17
BUILDING ADDRESS 1-7t 175, 17q, 1g,3 t�7 lk t
STREET : �� nlictfc,
SUBDIVISION: S
NORTH ARROW �a� lZ� (,v� iZ9' �
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CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPERV (PRINT) __...,
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STREET ADDRESS � E
f)6 ql DATE
TOWN r a � STATE ZIP INSPECTED BY TOWN
IOU ' t5 17 , DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER