HomeMy WebLinkAboutDrain Layers Permits 988 Main Street TOWN OF SOUTH- W I_N D_S O R, C T
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 11/27/2017
GIS ID: 54900988 FEE: 80.00
EXPIRATION DATE: 12/27/2017 MUMS APPLICATION# 201701681 ,*r\t'
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APPLICANI .{ LOCATION
NAME: D&S SEWER CONTICORS LiC ADDRESS 98 'MAIN STREET
ADDRESS: 332 MOORELAND TiO ,< OWNIyR HELKNAP TERRY A&JAMES G
BERLIN,CT 06037 9$8 MAIN STREET
1 SOUTH WINDSOR,CT 06074
PHONE
WORK DESCRIPTION: REPAIR
THE DRAIN LAYER ASSIGNED TO THISE$1NIIT HAS AkA>;I»LTC$1SE ISSU) D&�i'THL STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORTI;U'I THE=ATTACHED`C ?1�iDITI..QIR' I;L �?k�ORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDAS,tI,L OSHA REQUIREMENTS,ANb >FEE ATTACHED CONDITIONS.
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ISSUED BY DATE INSPECTED INSPECTED BY
11/27/2017 2:45 PM
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: 7G CONTRACTOR: �Su ,
LOCATION: q
TYPE OF WORK: �L p
DATE INSP NEEDED: DATE INSP:
INSPECTED BY:
WORK IN
PROGRESS:
744
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: ^IA� DATE:
S/molloy[forms 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: Xql� � {' Lot #
Street No. Street Name
Premises owned by:
Name of Firm: Phone:
Address of Firm: 3 r
TYPE OF WORK:
Lay House Drain ; Repair House Drain 7� ;
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 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 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. h! y 06J� PLEASE NOTE:
IF A SANITARY SEWER LATERAL
IS WITHIN 75 FEET OF A WELL
IT MUST BE AIR TESTED
Signed: Print Name: �ru�e e Eat- , �
Licensed Drain Layer
Date: Jl D i -7
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT REVISION 2017.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS
STREET : ZGj
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TOWN I STATE ZIP INSPECTED BY TOWN
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