HomeMy WebLinkAboutDrain Layers Permits 24 Lexie Lane 1700028 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
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DATE: 06/22/2017 °
GIS ID: 53450024
MUNIS APPLICATION# 201700774 4 x FEE' 0.00
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APPLIC
LOCATION
NAME: T&M BUILDING C( s INC c�DDRISS �24 EXIE LANE
ADDRESS: 110 BROOK STREE fi 1V1 UILDING CO INC
TORRINGTON,CT 0&, 9 's 1 0 B`>� lOK STREET
N y t} h s k X T(QlRI1WGTON CT 06790
PHONE 860-88 - 910? '
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WORK DESCRIPTION: BUILDT TC 6 ITS NI U�SI�SWEXt t f t `� -PR IT FEE
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THE DRAIN LAYER ASSIGNED TO THI ,PEFIT HAS A S1 1;IFSSSUED$Y�k� TI STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FOIIN THIJ ATTACiDr"CM4TDItT10I<T$'' L `6RK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDAtD$,ALL OSHAQIIREMETS� D ATTACHED CONDITIONS.
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ISSUED BY DATE INSPECTED INSPECTED BY
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: CONTRAC rOR:
LOCAM.N:
DATE INSP NEEDED; DATE INSP:
INSPECTED BY;
WORK IN
PROCRES' / /
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SEP-TIC-TANK:PUMPED;SMASHED,FILLED WITNESSED ❑YES ❑NO
AS-BUILT;
DATE• .
6/macym ms 2m Town of South Windsor YNPSELTrOwWOU 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:AC, —N3. ke'� $ -3
Street No. Street Name v �3
Premises owned by: ._._._!�40 n e,7
Name of Firm: /fc ��4..�74�, �[_ Phone:
Address of Firm:
TYPE OF WORK:
Lay House Drain Repair House Drain ;
Lay Main ; Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with 3 /�•�e
Existing Water Supply: Public Water Well
Proposed Start Date�zoazl? Estimated time for completion R 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 � f�s % L13 c �z the holder of Drain
Layer's License No. aaC . 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. a2a/7,,? .Yo 1'/ . PLEASE NOTE:
IF A SANITARY SEWER LATERAL
IS WITHIN 75 FEET OF A WELL
IT MUST BC�E''AIR TESTED
Sign Print Name:
Licensed Drain L r
Date:
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: '
BUILDING ADDRESS -Z Lc- LQAe
STREET : [Axie-
SUBDIVISION:
NORTH ARROW
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CONTRACTOR (PRINT) NAME OF C T CTOR' SUPERV (PRINT)
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STREET ADD ESS E
e�1'zlt�-/ DATE
TOWN STATE ZIP INSPECTED 8Y TOWN
5757- U DATE
TELEPHONE NUMBER v
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER