HomeMy WebLinkAboutDrain Layers Permits 10 Gilbert Lane 1700032 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
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DATE: 06/28/2017
GIS ID: 35300010i FEE: 60.00
MUNIS APPLICATION# 201700807 nke '}u n S <��> EXPIRATION DATE: 07/28/20I7
APPLICAN} ' LOCATION
NAME: JACQUES CONSTRI T O1 T(Jc}H1'�) 5 ADDRE,�S ' 0 GIP ERT LANE
ADDRESS: 67 RIDGE ROAD js � c fz OWNER 7ACSiES CONSTRUCTION LLC
SOUTH WINDSOR,C 06674 kl
46 RID GE ROAD
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ySISUT_IIWINDSOR, CT 06074
PHONE 860-43823 f '
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WORK DESCRIPTION: NEW StC 1�1NECIOI fi Y �� r ' 51
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THE DRAIN LAYER ASSIGNED TO THISWEI�],VIITk 11S tjwA��D IC>aNS ISS�Eb 3Y TI1 STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FOR H �3I ATTjACall)`COI�1pIT 0�S`'.°A�J �ORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDARDS, L OSHA 1tE(ZIIREMETaT1'S,AID SHE ATTACHED CONDITIONS.
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ISSUED BY DATE INSPECTED INSPECTED BY
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: z 7 OID314- CONTRACTOR:
LOCATION: --
TYPE OF WORK:
DATE INSP NEEDED: DATE INSP: = f
INSPECTED BY:
WORK IN
PROGRESS: el ' vZ_ 9AA � Pry_
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED [] YES [:] NO
AS-BUILT:
INPUT: (� `"' DATE:
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S/molloy/forms 2014 Town of South Windsor INPSECTION REPORT 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: z(2 (:�I'/b.cl Lzaot # -3
Street No. Street Name
Premises owned 6v� om
Name of Firm: Phone: ' rJe3® �
Address of Firm:
W/11�
TYPE OF WORK:
Lay House Drain ; Repair House Drain ;
Lay Main ; Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with L2 3!i
Existing Water Supply: Public Water t/ Well
Proposed Start Date �PEstimated 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 d; (, ° �= 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. PLEASE NOTE:
IF A SANITARY SEWER LATERAL
IS WITHIN 75 FEET OF A WELL
IT MUST BE AIR TESTED
Signed: LPrint Name::,C)�2/� C ' 1�
Lice rain Layer
Date:
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS
STREET
SUBDIVISION: ✓1 '
NORTH ARROWr�
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CONTRACTO . PRINT) NAM ONTRACTOR' SUPERVISOR (PRINT)
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�tEET ADDRES SI RE , j
DATE I
TOWN STATE ZIP INSPECTED BY TOWN
Z& DATE
TEL PHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER