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HomeMy WebLinkAboutDrain Layers Permits 16 Lexie Lane 1700026 TOWN OF SOUTH WINDSOR, CT PERMIT NUMBER DRAIN LAYER PERMIT DATE: 06/22/2017 GIS ID:53450016 ' ?s ;yT FEE: 64.00 MUNIS APPLICATION# 201700770 .0 EXPIRATION DATE: 07/22/2017 APPLICANTLOCATION NAME: T&M BUILDING CCU,INC �, ADDRESS 6 I EE LANE ADDRESS: 110 BROOK STREETiF $UILDING CO INC TORRINGTON,CT 00179y9 c y Ia`IRQOK STREET s 'p, j 4 xQRRIN TON,CT 06790 PHONE 860 88591p 7 5 cry p WORK DESCRIPTION: BUILDTI 2-3 1 6 NUS SE WER' tN �I�N ; k hv, 5 THE DRAIN LAYER ASSIGNED TO THIPERMI SU STATE AND HEREBY AGREES TO ALL k THE TERMS AND CONDITIONS SET FOR' I�1I�1�1I�r1�T�A�1I1;� fSNDITIOI�S' �I I~WORK SHALL BE IN ACCORDANCE WITH THE TOWN OF SOUTH WINDSOR STANDDS`ALL Q5HE1`RE( 71MEN'1 S AT `I HE ATTACHED CONDITIONS. C ISSUED B DATE INSPECTED INSPECTED BY 6/22/2017 12:32 PM pO V ,NN 6, mew ` L r y� Al 2� �M't� 2" '��`��' r .• is 4 �� �$ �'�' a �w.s r ..ate r � . . j TOWN OF SOUTH WINDSOR INSPECTION REPORT PERMIT NO:: 9 7 CONTRACrOR:,, t LOCATION: Ago TYPE OF WORK; ' DATE INSP NEEDED: DATE INSP.'-4 BY:_Lj1 WORK IN PROGRESS; ;wli,� SEPTIC TANK.PUMPED;SMASHED,FILLED WMESSED ❑YES ❑NO AS-BUILT INPUT: : DATE: 5/molloyMms2014 Tom of South Windsormrs: WWWORT14 ' 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: ,.� �� ____L # Street No. Street Name Premises owned by:_ `� Name of Firm: 7��.���c ��..� o►r .1.��_ Phone: Address of Firm: T,f TYPE OF WORK: Lay House Drain Repair House Drain ; Lay Main ; Lay Lateral for Commercial/Industrial Building of acres Connection will be made with C 22/2 3 5- R, ofie Existing Water Supply: Public Water Z,-� Well Proposed Start Date�' a?�' /? Estimated time for completion :� 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 % `2©s �z the holder of Drain Layer's License No. "aOC 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. YO -5",P 0"/ . PLEASE NOTE: IF A SANITARY SEWER LATERAL IS WITHIN 75 FEET OF A WELL IT MUST BE AIR TESTED Sign Print Name:, 7-21c� Licensed Drain Lr Date: Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc TOWN OF SOUTH WINDSOR SANITARY SEWER LATERAL FIELD LOCATION DATE OF CONSTRUCTION: � ' Z•6 - BUILDING ADDRESS : Z 0 `� Le. ! LIZA STREET Wit Lie. SUBDIVISION: �. 5 NORTH ARROW dP I i I __.l_-. _!T__I__�___�__ _J�__ �. -�__. ._ __ _�_ d--a__. CONTRACTOR (PRINT) NAME OF T CTOR' SUPERV (PRINT) STREET ADD ESS DATE TOWN STATE ZIP INSPECTED BY TOWN DATE j. TELEPHONE NUMBER I I WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER I