HomeMy WebLinkAboutDrain Layers Permits 2164 Ellington Road 1700047 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 09/01/2017 s
GIS ID:30302164 FEE: 60.00
MUNIS APPLICATION# 201701154 fi ` "r tit 4 EXPIRATION DATE: 10/0I/2017
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APPLICAN`I' k y LOCATION
NAME: JAMES J MARINO JIB C Va�TRIJGTION LC ADDRESS I64 i LINGTON ROAD
ADDRESS: 41 SMITH STREET 4 OWNli1 zWK ZHENG LI
EAST HAMPTON, T 06�424 z k 5�43 CLARK ST
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SOiTH WINDSOR,CT 06074
PHONE
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WORK DESCRIPTION: NEW SIW COI1fiCTYON
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THE DRAIN LAYER ASSIGNED TO THIS PFRfV1IT Ht�S A�17 ID LIONS ISSLJEI3 BY I'IIL STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FOR PHaIN H1 t1T7'A IL ED`COI�IDI IONS' AT L WbRK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDARDS,A R , FIF RV 4E ATTACHED CONDITIONS.
I UED BY DATE INSPECTED INSPECTED BY
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: 7 ���r'� CONTRACTOR:"Ta meE,�n— 1140'6 n 0 C'oos
LOCATION: lr � T,�, 4'r. i
TYPE OF WORK:
DATE INSP NEEDED: DATE INSP:
INSPECTED BY: �
WORK IN
PROGRESS:- c.t-k sc-+r
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SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT: '
INPUT: - DATE:
5/molloy/forms 2014 Town of South Windsor 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 Lot #
ZS jtNo. eet Name
Premises owned by:
Name of Firm: 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 LS
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 . e ' �u ,`� �, the holder of Drain
Layer's License No. 2-7l-- cD Onfy 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
Si ned: G Print Name:
9
l Licensed Drain Layer
Date: �//�
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: 9 �._./7
BUILDING ADDRESS -
STREET : 1=t.... 1�er'Trc: t� C !3
SUBDIVISION:
NORTH ARROW
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. ..........
-
,
CONTR CTO PRINT) NAME OF CONTRACTOR'S SUPERVISOR (PRINT)
STRE.Et ADDRES SIGNATURE
TOO N ATE ZIP INSPECTED BY TOWN
DATE
'EL PHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER