HomeMy WebLinkAboutDrain Layers Permits 9 Gilbert Lane 1700057 TOWN QF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 10/18/2017
GIS ID:35300009 x FEE: 80.00
MUMS APPLICATION# 201701473 EXPIRATION DATE: 11/17/2017
APPLICAIITST LOCATION
NAME: JACQUES CONSTR[ GTIQN ADDRESS. 9 GILBERT LANE
ADDRESS: 67 RIDGE ROAD OWNERTAGQUES CONSTRUCTION LLC
SOUTH WINDSOR,ACT 0`6p74 67 RIDGE ROAD
SDUT H WINDSOR,CT 06074
PHONE 8 6 0-4 3 183
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WORK DESCRIPTION: NEW S1�WE C�I�TI�TCTTi�IV
THE DRAIN LAYER ASSIGNED TO THIS PE&' I HAS A UALTD LICENSE ISS- D B NTH `STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FOR" I III 7HE ATIPI✓HI;D`CONDITIONS' ALL VORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDARDS,AI,L OS IA RE UI.REMEIWtS,AND TI E ATTACHED CONDITIONS.
ISSUED BY DATE INSPECTED INSPECTED BY
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: 1 -7.n00,S`l CONTRACTOR: Tq c Q
LOCATION: 9 " 1 t
TYPE OF WORK: -
DATE INSP NEEDED: DATE INSP: �2LIj lr
INSPECTED BY: 6_0
WORK IN
PROGRESS: 6" _u c Sh r 3
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SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑YES ❑ NO
AS-BUILT:
INPUT: ��'`� DATE: {
S/molloy/fiorms 2014 Town of South Windsor INPSECfiON 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: �efi 60 Lot #
Street No. Street Name
Premises owned by:
Name of Firm:_ _ Phone:
Address of Firm: 0 A e RV
TYPE OF WORK:
Lay House Drain ; Repair House Dra n ;
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 _
Existing Water Supply: Public Water 1 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 L the holder of Drain
Layer's License No. 30 my 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. 64 PLEASE NOTE:
IF A SANITARY SEWER LATERAL
IS WITHIN 75 FEET OF A WELL
IT MUST BE AIR TESTED
Signed: / Print Name: J&A
Licen ri ayer
Date: /� g
Standard Forms\Permits�PPLICATION FOR DRAIN LAYERS PERMIT REVISION 2017.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: 04 5: 7
BUILDING ADDRESSel
STREET
SUBDIVISION: Suln5c
NORTH ARROWDID
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I
73
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CONTRACTOR RENT) NAME OF CONTRACTOR'S ERVISOR (PRINT)
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STREET DDRE �G URE
TOWN STATE ZIP INSPECTED BY TOWN P'
DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER