HomeMy WebLinkAboutDrain Layers Permits 20 Shepard Way 1700054 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 10/10/2017
GIS ID: 82600020 F FEE: 80.00
MUNIS APPLICATION# 201701408 s EXPIRATION DATE: 11/09/2017
APPLICANT '� '
LOCATION
NAME: ATLANTIC EXCAV*TION,INC ADDRESS 20`SHRPARD WAY
ADDRESS: 363 PARUM ROAD F OWNER T&M BUILDING CO INC
COLCHESTER,CT,Obi} � I 0 BROOK STREET
TORRINGTON,CT 06790
PHONE -
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WORK DESCRIPTION: NEW S2.WEAC?NI`TECTI(3N
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THE DRAIN LAYER ASSIGNED TO THIS PEIt1IIT Hp.S A V[ LID LICENSE ISSUED$�'T'H£STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORM IN TI 'ATTACHED`CC3NDI`)IOlyS' ALL WORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDA�ItDS, #LI OSHA'"RE4TJIREIVIENTS,AND TBE ATTACHED CONDITIONS.
ISSUED BY DATE INSPECTED INSPECTED BY
10/10/2017 11:57 AM
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: Cl CONTRACTOR:. c _
LOCATION: 30 swaf tw - -- -- -
TYPE OF WORK: " ICE
DATE INSP NEEDED: DATE INSP: 01�,23
INSPECTED BY 0 b
WORK IN
PROGRESS: r " ` a {�L 5� 3 S
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SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: DATE: f
S/molloy/forms 2o14 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: 70 Lot #
Street No. -- treet Name
Premises owned by:
Name of Firm: �'!�-� �,�,� ,a*-� ��r _ Phone:
Address of Firm: 3C3 C C %
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 �' 5DI1
Existing Water Supply: Public Water Well
Proposed Start Date Estimated time for completion LY
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 the holder of Drain
Layer's License No. 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. C9/7 e?c) PLEASE NOTE:
IF A SANITARY SEWER LATERAL
IS WITHIN 75 FEET OF A WELL
IT MUST BE AIR TESTED
Signed;-"" Print Name:
Licensed Drain La
Date: to b
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Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT REVISION 2017.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: to' 2�5 - I7
BUILDING ADDRESS C '� LA-4 17
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SUBDIVISION: e
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CONTRACTOR (PRINT) NAME OF CONTACTIOWSLS RV (PRI }
STREET DRES S ll
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TOWN STATE ZIP INSPECTED BY TOW
DATE
TELEPHONE NUMBER
WHITE — TOWN PINK — CONTRACTOR YELLOW — CONSULTING ENGINEER / DEVELOPER