HomeMy WebLinkAboutDrain Layers Permit 23 Barbara Road 1700025 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
1 4 u
DATE: 06/20/2017
GIS ID: 07500023 n FEE: 60.00
MUNIS APPLICATION# 201700751 ` Ys �kj` } « ' r` EXPIRATION DATE: 07/20/2017
;V V, S 4
APPLIC T >' LOCATION
NAME: SKIPS WASTEWATER S z ADDR1;Sx f:jl;BAABARA ROAD
ADDRESS: 21 COURTNEY DRIL 5 u w OW1VE
A pv RAND,42Z0 FRANK J
ELLINGTON,CT OHO f �w 3 air 2iR13ARA ROAD
TarNOU'YIIIVINDSOR,CT 06074
PHONE 860-87 2332
lt,j
oll
A �S `x ,
WORK DESCRIPTION: NEW SKM R GQ CTIQN y ��4k�u,ref k
��
THE DRAIN LAYER ASSIGNED TO THISPEZiJVII"I'HAS A�V?�I,D 17T ` Iu TSUEI 'BYIiF STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET L WRK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STAND.ALD ,t�LL fliSHA 11E' UTRFsMENTS DI ATTACHED CONDITIONS,
ISSUED BY DA E INS ECTED INSPECTED BY
6/20/2017 3:13 PM
x
V{ `X
Z
Z - F4,lSJ�,k
�..� i'Y
FAR�rJuf�
�4 h`"t
Y
Yy'St � "�Y"Y 4 3 ` ��'C �•L �"L� 'i� F lh: �T"5.1 ��.
.e a��% �[ �`ry� � �����Fr sib` 'Y.�UYti,. �� �?s r�M h�3�,�:• �h.
y
'`
IV—REPORT
TOWN OF SOHTH WINDSOR INSPECT
PERMIT NO:: l`7PC& CONTRACTOR:, ,YYK1
LOCATION:
TYPE OF WORK: LJ&cJ n n-.4
DATE INSP NEEDED: DATE INSP:
INSPECTED BY:
WORK IN
PROGRESS: Zt
r .r• `` '� e ..
SEP-'TIC-TANK PUMPED;SMASH9D,FILLED WITNESSED ❑N0.
AS-BUILT
INPUT: DATE*
S/molloy/Pomts 2014 Tom of South Windsor MPSWa0fTREP0l(r 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: & 9 2 Lot #
Street No. Street Name
Premises owned by: /27 19/1/IPfi zzo
Name of Firm: Phone:
Address of Firm: 2 COY tz- C4
TYPE OF WORK:
Lay House Drain ; Repair House Drain ;
Lay Main ; Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with PVC
Existing Water Supply: Public Water -y-"- 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 � fu ALl�i✓ �-- thetolder of Drain
Layer's License No. Q-7o q'7 Z r . Only holders of P-1 P-7 r 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. 1;2 °i.7 PLEASE NOTE:
IF A SANITARY SEWER LATERAL
IS WITHIN 75 FEET OF A WELL
IT MUST BE AIR TESTED
Signed:- Print Name: A/ k-€ IL
Li ensed Drain Layer
Date: &M 9 / 7
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMTT.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: /7
BUILDING ADDRESS
STREET
SUBDIVISION:
NORTH ARROWto I
4 Iflf
y
CONTRACTOR (PRINT) ) NA OF QgNTRACTO ' SUPERVISOR (PRIM
(5q!A-y "ill -,�- -- A
STREET DRESS SIGN T
l C r Z ATE
�✓ �- 1 eAl
TOWN STATE ZIP INSPECTED B TOWN
DATE
TELEPH NE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER