HomeMy WebLinkAboutDrain Layers Permits 20 Lexie Lane (2) 1700027 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 06/22/2017
GIS ID: 53450020 r `
FEE: O.QO
MUNIS APPLICATION# 201700773 4. "' k +;. EXPIRATION DATE: Q7/22/2017
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APPLICANT "> r 3 "«w � �>t� � 5 � � LOCATION
NAME: T&M BUILDING CQ INC 4 ADDRE0 I;EXIE LANE
ADDRESS: 110 BROOK STREE
OWNED ,T 8 M) UILDING CO INC
TORRINGTON, CT6 7�`0kROK STREET
, rx� 52; yz TQRRINGTON,CT 06790
PHONE 860-88 5910 'x z h, Z E S L
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WORK DESCRIPTION: BUILDING "�C7T5 N] U�'SE�1��Q� ECTON }
PERMIT%ME11 EGTEDQ1RPL�GAIOI�T��0I70.I70
THE DRAIN LAYER ASSIGNED TO THI EtR1uIT�I1?,S A yA1tIJ3 DTIIS �UI B �NySTATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORfIN TII;,[��IACI �r°GON1?IIQN tyl,ir VZ}Ri{SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STAND ;�1`LL OSIA= tC1i`> EMEL`TiS; �TIIE ATTACHED CONDITIONS.
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ISSUED DATE INSPECTED INSPECTED BY
6/22/2017 12:54 PM
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMTf NO. CONTRACTOR; ° v AA �'��
LOCATION: 20 ZL X �
TYPE OF WORK:
DATE INSP NEEDED; DATE INSP; I
INSPECTED BY;_ab '
WORK IN .
PROGRESS: e� - -
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SEPTIC TANK.P-UMPED;SMASHED,FILLED WITNESSED ❑YES ❑NO
AS-BUILT:
INPUT: DATE-
S/mallay/forms2014Town of South Windsor Il11PSWWQWWORT14 "'
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: y
Street No. Street Name
Premises owned by:
Name of Firm: ��ti��c �-�..� �► �_ Phone: "R60
Address of Firm:
TYPE OF WORK:
Lay House Drain L� Repair House Drain ;
Lay Main ; Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with
Existing Water Supply: Public Water � Well
Proposed Start Date�' �?�' /? 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 �. s_ % Z?6d c .z the holder of Drain
Layer's License No. _. ,5"00C . 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. y(f) 3,P kr. PLEASE NOTE:
IF A SANITARY SEWER LATERAL
IS WITHIN 75 FEET OF A WELL
IT MUST BE AIR TESTED
Sign : Print Name: 7 ,_Ja ,
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 0 Ct La LQ
STREET : Lemkic—LaAc
SUBDIVISION:
NORTH ARROW
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CONTRACTOR (PRINT) NAME OF C T CT R` SUPER V (PRINT)
STREET ADDRESS E
DATE
TOWN STATE Zip INSPECTED BY TOWN
90 DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW -- CONSULTING ENGINEER / DEVELOPER