HomeMy WebLinkAboutDrain Layers Permits 14 Shepard Way (2) 1.700053 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER
DRAIN LAYER PERMIT
DATE: 10/10/2017
GIS ID: 82600014 ,
MUNIS APPLICATION# 201701407 ,r y. ,, PEE: 80.00
EXPIRATION DATE: 11/09/2017
APPLICANT'
NAME: ATLANTIC EXCAVATIQN INC LOCATION
ADDRESS: 363 PARUM ROAD ADDRESS: 14'SH1xxPARD WAY
OWNER i &.M BUILDING CO INC
COLCHESTER,CT 064I5
1 I Y BROOK STREET
PHONE TO13INGTON, CT 06790
WORK DESCRIPTION: NEW SFWI✓R PT,
90
IICTI'ON
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THE BRAIN LAYER ASSIGNED TO THIS PEJt1IT HAS A VALID I.ICENSEJSSUI♦D B THE STATE AND HEREBY AGREES
THE TERMS AND CONDITIONS SET FORTH TN HE ATTACHED`CONI�ITIOIgIS' `ALL WORK SHALL BE IN ACCORDANCE WITHL
THE TOWN OF SOUTH WINDSOR STANDARDS,AI L OSHA REQLIIREMEI TT$ ACID THE ATTACHED CONDITIONS.
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ISSUED.BY DATE INSPECTED INSPECTED BY
10/10/2017 12:04 PM
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: U 7000S; CONTRACTOR:. A I Any-6
LOCATION: 11 �-S"kV a4
TYPE OF WORK:
DATE INSP NEEDED: DATE INSP: /,0//7//7
INSPECTED BY: QD
WORK IN
PROGRESS:
TF 0 - 1.4�e _ f1 �l2•°irl� Slee"c Too
f. ' Y --•
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: DATE: r
S/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 $80.00
Location of proposed work:J_ZZ Lot # z�
Street No. Street Name
Premises owned by: U
Name of Firm: 7 c ,_ '� Phone: !R:-o- 73,�I- /l76'
Address of Firm: f 1C.3 7.
TYPE OF WORK:
Lay House Drain z,-- ; Repair House Drain ;
Lay Lateral for building with connection ; or no connection
Lay Main
Lay Lateral for Commercial/Industrial Building number of acres
Connection will be made with _ 6' e" zae C
Existing Water Supply: Public Water Well
Proposed Start Date Zez111 7 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 111:�Zl-zrc I&CW6,1Z fiA/� the holder of Drain
Layer's License No. eVe ryz?Y /'?Z. 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.
C B Y D No. ,l 2 PLEASE NOTE:
IF A SANITARY SEWER LATERAL
IS WITHIN 75 FEET OF A WELL
IT MUST BE AIR' TESTED
Signe Print Name: �.C���
Licensed Drain Layer
Date: fo c
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT REVISION 2017.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: Z-01/7117
BUILDING ADDRESS
STREET
+ SUBDIVISION:
NORTH ARROW
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CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPERVI PRINT)
STREET ADDRESSSIGNATURE
_ C,.,a fie- .4 Ice- oc I-.E fdli al ATE -
TOWN STATE ZIP INSPECTED BY TOWN
DATE
TELEPHONE NUMBER
WHITE -- TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER