HomeMy WebLinkAboutDrain Layers Permits 100 Pepin Place 1700061 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
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DATE: 11/08/2017
GIS ID: 70700100 a FEE: 80.00
MUNIS APPLICATION# 201701598 pry EXPIRATION DATE: 12/08/2017
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APPLICANT ' .. �� LOCATION
NAME: ATLANTIC EXCAVt�`i,'ION,TNC, ADDRESS 0{fPEtIN PLACE
ADDRESS: 363 PARUM ROAD n QWNER k,s & UILDING CO INC
COLCHESTER,CT.QG41 <_ s ]10 BROOK STREET
'`TbRRINGTON,CT 06790
PHONE
WORK DESCRIPTION: NEW S�WB�GONNCTIONBUTLDINCr �I I00,1�D4,I0$,11 ,116,120
THE DRAIN LAYER ASSIGNED TO THIS�ERI�IIT HAS A VIbrCENS1 ISSD$ T�IIr STATE AND HERESY AGREES TO ALL
THE TERMS AND CONDITIONS SET FOR' Z.
zH'iI�1 1 HEATT^ACH11D`C4NDI')IQNSS, L LO1tK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDARDS,AL E ATTACHED CONDITIONS:
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ISSUM BY DATE INSPECTED SPECTED BY
11/8/2017 9:43 AM
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: 7 CONTRACTOR: A"t tt )
LOCATION; d lif10,
TYPE OF WORK: 1
DATE INSP NEEDED; DATE INSP; r t
INSPECTED BY:
WORK IN �� �..,
PROGRESS: * 6 s2 - 2415 Ccnj►jW--rFJ - 9.A�-kPj l j
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SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES [] NO
AS-BUILT: L/
INPUT: DATE;
S/mol[oy/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 $80.00
Location of proposed work: !:m:1 )PzkC Lot #
Street No. S reet Name
Premises owned by:
Name of Firm: �7'•� „ �. 7� Phone:
Address of Firm:
TYPE OF WORK:
Lay House Drain ; Repair House Drain ;
Lay Lateral for building with connection ✓, or no connection ;
Lay Main
Lay Lateral for Commercial/Industrial Building number of acres
Connection will be made with 4�0'
Existing Water Supply: Public Water Well
Proposed Start Date i Estimated time for completion
ALL WORK TO BE IN ACCORDANCE WITH TOWN OF SOUTH WINDSOR STANDARDS,
ALL OSHA REQUIREMENTS AND CONDITIONS ATTACHED TO THE PERMIT
Permit is to be issued to 1�2�--- .... . Z—� . the holder of Drain
Layer's License No. Only holders of P-1, P-7 or W-9 licenses
will be issued a permit. PERMIT WILL EXPIRE THIRTY (30) DAYS AFTER
DATE OF ISSUANCE. The undersigned Drain Layer hereby agrees to all the terms
and conditions set forth in the permit and attached thereto. Applicant has received
Town Street Excavation Permit No. and/or ConnDOT Permit No.
CBYD No. ??alb f'�9�'�3 C' ��_. PLEASE NOTE:
IF A SANITARY SEWER LATERAL
IS WITHIN 75 FEET OF A WELL
IT MUST BE AIR TESTED
Sig Print Name: r—
Licensed Dr ' Layer
Date: / 8
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT REVISION 2017.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: i®�$'� 7
BUILDING ADDRESS c A
STREET : l
SUBDIVISION:
NORTH ARROW
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CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPERVISOR (PRINT)
STREET ADDRESS SIGNATURE
fP-/,,, nc al,5pitl�^� �� �N�7 DATE
TOWN STATE ZIP INS ED BY TOWN
-02�3 -/'!% DATE
TELEPHONE NUMBER
WHITE - TOWN PINK -- CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER