HomeMy WebLinkAboutDrain Layers Permit 006 Arnold Way 1700059 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 11/01/2017
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GIS ID: 04500006 r FEE: 80.00
MUNIS APPLICATION# 201701565 EXPIRATION DATE: 12/01/2017
APPLICANT ' s t 2 ' <�� 0 LOCATION
NAME: SKIPS WASTEWAT41R �1DDRE S A OLD WAY
ADDRESS: 21 COURTNEY DRIi�/E <? O WNlrlt L NITE6 BANK RESIDENTIAL PROPERTIES
ELLINGTON,CT 00O29� 3 4 9� FAI VIINGTON AVE STE 200
N� "� f " `` `)FHARTFORD,CT 06107
WEB
PHONE 860-87 2 2 S
4.7,1SS 1A .
WORK DESCRIPTION: NEW SWIsbCTI01�
THE DRAIN LAYER ASSIGNED TO THI§kkPEI \+II'1 IIAS A� IALYD LI �NSE SSiII{I}$S2 T STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORSI fiN HE ATTACD` C2DI IO+1S' ,ALJ WORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDARD,AI_J,OSHA REQUI v ATTACHED CONDITIONS.
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: - CONTRACTOR: iG_S
LOCATION: y '
TYPE OF WORK: ? Leltlat, �l'I
DATE INSP NEEDED: DATE INSP: d
INSPECTED BY: f-b
WORK IN
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INPUT: �` -�' DATE: I
S/molloy/forms 2014 Town of South Windsor INPSECTION REPORT 14
1
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: AA-AiOLD 40/9Y Lot #
Street No. Street Name
Premises owned by: Boa E , M 4A/'77-7
Name of Firm: S/��r�S G�/�TTc Phone: �a
Address of Firm:
TYPE OF WORK:
Lay House Drain ; 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 S't 3 57
Existing Water Supply: Public Water >'-- Well
Proposed Start Date Estimated time for completion 1xUo U '
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 —7P'` Z, /tF rz— the holder of Drain
Layer's License No. o ?a -7'�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.
CBYD No. o/7 ' -0 r s"��� PLEASE NOTE:
IF A SANITARY SEWER LATERAL
IS WITHIN 75 FEET OF A WELL
IT MUST BE AIR TESTED
Signed: Print Name: � �►� Irr/ Z� I�
Lice sed Drain Layer
Date: /f �,
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT REVISION 2017.doc
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TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: 1/A 7
BUILDING ADDRESS
STREET
SUBDIVISION:
NORTH ARROW
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CONT�R (PRINT) NAME OF CONTRACTOR'S SUPERVISOR (PRINT)
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STREET ADDRESS SIGNATURE
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TOWN STATE ZIP INSPECTED BY TOWN
i0C,C ? DATE
TELEPHONE NUMBER
WHITE — TOWN PINK -- CONTRACTOR YELLOW — CONSULTING ENGINEER / DEVELOPER