HomeMy WebLinkAboutDrain Layers Permits 565 Pleasant Valley (2) 1700021 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER
DRAIN LAYER PERMIT
DATE: 05/18/20I7
GIS ID: 72900565A'iF5 s
MUNIS APPLICATION# 201700565
FEE: 0.00
4; EXPIRATION DATE: 06/17/2017
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APPLICANT LOCATION
NAME: ENVIRONMENTAL, ER,VICES
ADDRESS: 90 BROOKFEILD SI"RExT� "; ADDR>;'S 4565'PI3 ASANT VALLEY ROAD
s Q R SOS, TH£WINDSOR TOWN OF 45
SOUTH WINDSOR'g �?GO74 h ti �r r P .Et1SA NT VALLEY ROAD
PHONE Y ' rtTIH�WINDSOR, CT 06074
860-52 9500 k , ;,.
WORK DESCRIPTION: NEW Si%w qOm"N''. CTIbN E1T` MPS ( [P ? C FEE
THE DRAIN LAYER ASSIGNED TO THIPEITTITIS A VAT�fIJ LIEN ETSSiD'BY
THE TERMS AND CONDITIONS SET FORTT IN TfTE ATA [ 15`CO�IYONSd STATE AND HEREBY AGREES TO ALL
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THE TOWN OF SOUTH WINDSOR STAND l2I DS,ALL OSHA 1 ITTKEME''TS SHALL BE IN ACCORDANCE WITH
F _ { ;Alm THE ATTACHED CONDITIONS.
ISSUED BY DATE INSPECTED. INSPECT D Y 5/1 8/201 7 3:10 PM
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TOWN OF SOUTH WINDSOR INSPECT3ON REPORT
PERMIT NO:: i l noo a-1 CONTRACTQR
LOCATION: ��t, .5� Ii�. �i3 rQ_ _ 112!� .
TYPE OF WORK:
DATE INSP NEEDED: DATE INSP: _, /7
INSPECTED BY:
WORK IN .
PROGRESS 1 5 • ,> c.rc. s®�x -'
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SEPTIC TANK.PUMPED;SMASHED,FILLED WITNESSED ❑YES ❑NO
AS-BUILT: ' ,.,,•,
DATE.
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S/molloy/fonns 2014 Towm of South Windsor INFSECTlDN'tS Olff 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: C-A C- F U II Lot #
Street No. Street Name
Premises owned by: D vik) 0 �� �IJ INO Su A,
Name of Firm: E-N 1 wM Phone: �((2 3W 7,5
Address of Firm: 0 Eau o'- C P �-6 L'k)os-o
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 / Estimated time for completion
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 ly,111,�l t older of Drain
Layer's License No. Only olders of P-1, - 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. -AY and/or ConnDOT Permit No.
CBYD No:/ PLEASE NOTE:
IF A SANITARY SEWER LATERAL
IS WITHIN 75 FEET OF A WELL
IT MUST BE AIR T T
Signed: Print Name:
9
Licen ed in Layer
Date:
Standard Farms\ rmits\APPLICAl'ION FOR DRAIN LAYERS PERMIT.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: j r�
ADDRESS : � �BUILDING
STREET :
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CONTRACTOR (PRINT) NAME OF CTOR'S SUPER OR (PRINT)
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STREET ADDRESS SIG ATU Rt
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TOWN ��,!,11 Q ( STATE ZIP INSPECTED BY TOWN
bV 6"d-0 - ! �5 00 DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER