HomeMy WebLinkAboutDrain Layers Permits 28 Lexie Lane 1700029 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 06/22/2017 All{
GIS ID:53450028N16FEE: 0.00
MUNIS APPLICATION# 2017007754 Ilk,
z „ 5�, EXPIRATION DATE: 07/22/2017
APPLICANT i y �Kt. Y k'r z 4� �• LOCATION
NAME: T&M BUILDING C INC `
ADDRESS 2 LEJIE LANE
ADDRESS: 110 BROOK STREEI' j f dNEl &M$UILDING CO INC
TORRINGTON, CT f�}6-79 y' , i d�$1�C�OK STREET
tl 4 r 4-T tbRI1CrTON,CT 06790
PHONE 860-88�-5910' `t` 3
WORK DESCRIPTION: BUIL *14"Z r 6�UNITS Nlxh�SI WER j � 0 pEg IT FEE
COLLEfiE`IO APP 201Q0ti7,(1 ,x
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THE DRAIN LAYER ASSIGNED TO THIgEII!lTr,.TIAS kV 1T 1I31 x 1;rrsr; SSu>fiISTATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FOR TIN 1TB pT �i1r IE?� Q*NDjTIO SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDAifi,,4L OHAFI�EQITIIIME �S,A117 T[I ATTACHED CONDITIONS.
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ISSUED BY DA SPECTED. INSPECTED BY
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Tow.m OP soutH 1NYND,SDR INSPEcriQN REPORT
PERMIT No.; 700W CONTRACT{OR:_
LOCATION: Lim
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TYPE OF.WORK-&GO SPULLOfo " �
DATE INSP NEEDED; DATE INSP: � 1
INSPECTED BY:
WORK IN
PROGRESS.
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SEPTIC TAN K:PUMPED;SMASH9D,FILLED WITNES$ED [:]YES ❑N0
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INPUT. DATE• 113.1
S/malloy/Mrms E14 Town of S'oum wlndw INPSf=lf WP0W 14
APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $60.00
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Location of proposed work: ��-20, �; ��'�o a �.3C
Street No. Street Name X*11 v �3
Premises owned by: —,7
Name of Firm: �.� 7��c c�.�� an .�e_ Phone: -eco
Address of Firm: r.-
TYPE OF WORK:
Lay House Drain Repair House Drain ;
Lay Main ; Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with 2.2 2 3 3- /%�✓e
Existing Water Supply: Public Water Well
Proposed Start Date�' �7� /7 Estimated time for completion Z�? s
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 CA�.�¢s % ZL c � the holder of Drain
Layer's License No. S`oaC 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. tea/7aP y4 .� .�. PLEASE NOTE:
IF A SANITARY SEWER LATERAL
IS WITHIN 75 FEET Of A WELL
IT MUST BE AIR TESTED
Sign Print Name: Cam.da s �ac�
Licensed Drain L r
Date.
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMrT.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: ' Z.6
BUILDING ADDRESS : xzo, 14 Lcy-L bQe
STREET : [=exie- 4u_
SUBDIVISION:
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STREET ADLLbbi U E
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TOWN STATE ZIP INSPECTED BY TOWN
ntfqo DATE
TELEPHONE NUMBER
WHITE — TOWN PINK — CONTRACTOR YELLOW — CONSULTING ENGINEER / DEVELOPER