HomeMy WebLinkAboutDrain Layers Permits 165 Rosemary Lane 1700067 TOWN OF SOUTH WINDSOR, CT
DRAIN LAYER PERMIT
DATE: 11/27/20I 7
GIS ID:77400165 FEE: 80.00
MUNIS APPLICATION# 201701670 G 7 EXPIRATION DATE: 12/27/2017
APPLICANT LOCATION
NAME: CLOG MASTER LLCM t tADDRESa �65.ROEMARY LANE
ADDRESS: 71 CHURCH AVE y '` , OTEIZ1ZICE LIMBERLY A
BRISTOL,CT 06016 a 165 ROSEMARY LANE
40,
K f S�3iJTH WINDSOR,CT 06074
PHONE 860-709"8427
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WORK DESCRIPTION: CLEAR16D C� 6G(`r
THE DRAIN LAYER ASSIGNED TO THIS_E>3MIT HAS A VALID LI��NSE ISSUEb B�TI�STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORTFI'M THE ATTACIED`COL*1DITIONS' ALL CORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDARDS,ALL bSI x RE iJ.i.REMEN'TS.A1�ID )(fB ATTACHED CONDITIONS.
ISSUED BY DATE INSPECTED INSPECTED BY
1 1/27/201 7 9:22 AM
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: 1 -7.Qa0( CONTRACTOR:
LOCATION:
TYPE OF WORK: �' !��' l 4 °► _ 1
DATE INSP NEEDED: DATE INSP:
INSPECTED BY: l
WORK IN
PROGRESS:
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SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: � DATE: ) `
S/molloy/forms 2014 Town of South Windsor INPSECrION 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:. 40- Lot #
Street lNo. Stre t Name
Premises owned by:
Name of firm: �I �_c._�ti`c_�S �-�.,� Phone:
Address of Firm: L C U,w L. J\q- r;-S L( C)Cca►Z5
TYPE OF WORK:
Lay House Drain ; Repair House Drain w/ ;
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 o to+�
I
Existing Water Supply: Public Water Well
I -
Proposed Start Date H)q)\q 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 C, 16 c vk— the holder of Drain
Layer's License No. O ace S , . 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. 3L (4 PLEASE NOTE:
IF A SANITARY SEWER LATERAL
IS WITHIN 75 FEET OF A WELL
IT MUST BE AIR TESTED
Signed: .T_., Print Name:
Licensed Drain Layer
Date: Nr
Standard Forts\Perm1ts\APPUCALn0N FOR DRAIN LAYERS PERMIT REVISION 2017.doc
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T_O_W-N O-F----S-O_U_T_H-- -_W_I N D S O-R-- -------- - ----
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: /I ®7 /-7
BUILDING ADDRESS
STREET __ '�'c rw�J Y`'P G f=A,
SUBDIVISION:
NORTH ARROW }
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CONTRACTOR PRINT) NAME OF CONTRACTOR'S SUPERVISOR (PRINT)
STREET ADDRESS SIGNATURE
DATE
TOWN STATE ZIP INSPECTED BY TOWN
M _ 1 7 DATE
TELEPHONE NU'BER
WHITE — TOWN PINK — CONTRACTOR YELLOW — CONSULTING ENGINEER / DEVELOPER