HomeMy WebLinkAboutDrain Layers Permits 17 Chaponis Way 1700048 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMI3ER DRAIN LAYER PERMIT
DATE: 09/01/2017
GIS ID: 18270017 �v f FEE: 60.00
MUNIS APPLICATION# 201701155 '3y EXPIRATION DATE: I0/01/2017
APPLICANT' LOCATION
NAME: EAGLE EARTHWORk SERi1 ADDRESS i CHAPONIS WAY
ADDRESS: 101 N MOUNTAIN IO`A�b rk OWNER *ANN1RIN0 BUILDERS LLC
CANTON, CT 06014Y �100 CHAPEL ROAD#3F
SO�JT�IaWINDSOR,CT 06074
PHONE 860 693 2070 'r
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WORK DESCRIPTION: NEW SyWt
THE DRAIN LAYER ASSIGNED TO THI n E IITS, S A I ID LYCENS$ISSiJ$D j3tT IE STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FOR HTNHE;ATTA11Ep`G�C?11�TT01�TS ALLQRK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDt1kp ,A L OSLIt REQTJIREIv11NN'1'S,AND THE ATTACHED CONDITIONS.
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: imc CONTRACTOR:
LOCATION:_ ! r (upy.(215 .,.._(Ala
TYPE OF WORK: yJ C�pu)--6,L (art r,n el,fp n
DATE INSP NEEDED: DATE INSP:
INSPECTED BY: 6
WORK IN
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SEPTIC TANK PUMPE�SMMED, FILLED WITNESSED ❑YES ❑ NO
AS-BUILT:
INPUT: 1 DATE: 1
S/Molloy/forms 2014 Town of South Wlndsor INPSEMON 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: 2 ► j!L)jZ Lot #�
Street No. Street Name
Premises owned by:
Name of Firm: �!� �'' _ Phone: 93
Address of Firm:�6 /j/,�✓ T�r {; DZ�, �� �6 1�'
TYPE OF WORK:
Lay House Drain ; 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
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 /` A� the holder of Drain
Layer's License No. l 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. 2VI 7 PLEASE NOTE:
IF A SANITARY SEWER LATERAL
IS WITHIN 75 FEET OF A WELL
IT MUST BE AIR TESTED
Signed: Print Name:
Li nsed Drain Layer
Date: �-
Standard FormsTermits\APPLICATION FOR DRAIN LAYERS PERMFr,doc
TOWN OF SOUTH WINDSOR
SANITARY SEWERIATERAL FIELD LOCATION
DATE OF CONSTRUCTION: 0:2
BUILDING ADDRESS
STREET
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TOWN STAT ZIP INSPECTED BY TOWN
24C® '113 DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER