HomeMy WebLinkAboutDrain Layers Permits 668 Governors highw 1700024 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 06/07/2017
GIS ID:36900668 FEE: 60.00
MUNIS APPLICATION# 201700628 s �r�r �, z i 4; EXPIRATION DATE: 07/07/2017
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APPLICAN§T �' 4 �� t> LOCATION
NAME: JOEL MARTIN ` " ADDRESzS b $GVERNORS HIGHWAY
ADDRESS: 256 MOUNT PARNAISI RC, ROA HEIDI L
EAST HADDDAM, T'0643 r \ \
G07ERNORS HIGHWAY
SOUTH WINDSOR,CT 0607�1
PHONE 860-30621 ° s
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WORK DESCRIPTION: NEW SWTROFIECTIEI r � k
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THE DRAIN LAYER ASSIGNED TO THIkPE N I S t� SENSE XSSUEI BY NHL STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORT IN TH>wr ACHIiI�` f�1�1DfTTOFS' .ALL WfbRK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STAND. DS;�AI L OSHA RI f�UI1V1E 'S;A1D THE ATTACHED CONDITIONS.
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ISSUED BY DATE INSPECTED INSPECTED BY
6/7/2017 1 1-15 AM
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TOWN OF SOUTH WINDSOR INSPECTIQN REPORT
PERMIT NO:: 170
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LOCATION.
TYPE OF
DATE INSP NEEDED: DATE INSP.-
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WORK IN '
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5/molloy/burns 2014 Town of south Windsor mpso TiO fREPOW 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:LE m Dc Lot #L
Street N6. Str t Nime
Premises owned by: ob t
Name of Firm: �C�e1 Ma a Phonel01 661� �
Address of Firm:� �1� ��t CSCy5C� ��
TYPE OF WORK: {�
Lay House Drain Repair House Drain ;
Lay Main ; Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with S (-, c,y
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
J0-C l 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. 15 PLEASE NOTE,-
IF A SANITARY SEWER LATERAL
IS WITHIN 7S FEET OF A WELL
IT MUST BE AIR TESTED
Signed: Print Name:�U� ���1
Licensed Drain Layer
Date:
Standard Forms\Permlts\APPLICATION FOR DRAIN LAYERS PERMIT.doc t
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: 4�Lt-?Tbz
BUILDING ADDRESS 6& 8
STREET � �
SUBDIVISION:
NORTH ARROW
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C RACTOR (PRINT) NAME OF C TRACT SUP OR (PRINT)
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STREEt ADDRESS SIGNATUR
,4S DATE
TOWN STATE ZIP INSPECTED BY TOWN
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131 6) 7 DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER