HomeMy WebLinkAboutDrain Layers Permits 890 Strong Road (2) 1700020 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 05/16/2017 �
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GIS ID:87000890 y � FEE: ,_60.00
MUNIS APPLICATION# 201700551 ,` EXPIRATION DATE: 06/15/2017
APPLIC � ,�;
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NAME: JAMES THROWE D DD 0'S ONG ROAD
ADDRESS: 97 RIVERSIDE DR- `
„ �. � ;�. s� �' � �� ;;S. ...GRIDIVI
VERNON ROCKV �QSD6I� ONG ROAD
PAR �� � v. DSOR,CT 06074
PHONE 860-28 -0095 , �� : a
WORK DESCRIPTION: NEWSAk
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THE DRAIN LAYPR ASSIGNED TO THI E. 5. SS STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FO € 1 f 1 1 5 RK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STAND I3Pt =' S'- p ATTACHED CONDITIONS.
ISSUED Bt 6A- E INSPECTED INSPECTED BY
5/16/2017 2:46 PM
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
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PERMIT NO:: COO.� 0 CONTRACTOR: V a ilS ZJr -
LOCATION: 820
TYPE OF WORK: t1 i ' i
.41
DATE INSP NEEDED: DATE INSP: .S"'
INSPECTED BY: =
WORK IN
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PROGRESS~ ., ,ti,s l� 'yc SOR
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. SEPTIC TANK.PUMPED;&MASHED,FILLED WITNESSED ❑YES ❑NO
AS-BUILT: `' • -
INPUT: DATE: '
S/molloymms tom Town of&bth Windsor INPSECTiON`REPOW 14
APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $50.00
Location of proposed work: S 7U K J Lot #
Street No. Sireet Name
Premises owned by: L,
Name of Firm: / < - , Phone: c��5
Address of Firm /33c) 6nlzti-,-, S�
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 Q O Y / 7 Estimated time for completion l"M11 Y 7
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 the holder of Drain
Layer's License No. �' . 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. PLEASE NOTE:
IF A SANITARY SEWER LATERAL
IS WITHIN 75 FEET OF A WELL
IT MUST BE AIR TESTED
Signed: Print Name: �r� -----
Licensed Drain Layer
Date: �6 M Y 17
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMrr.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: a"" �1EyZl
BUILDING ADDRESS : 8"�: 0
STREET :
SUBDIVISION:
NORTH A ROW
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CONTRACTOR (PRINT) NAME OF CONTRACTO=PERVISOR' RINT)
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-- LA-A-ON�
STREET ADpRESS SIGNAIVE
DATE
TO STATE ZIP INSPECTED BY TOWN
oc DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER