HomeMy WebLinkAboutDrain Layers Permits 50 Lexie Lane 1700074 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 12/07/2017
GIS ID:53450050 FEE: 0.00
MUNIS APPLICATION# 201701757 EXPIRATION DATE: 0I/06/2018
APPLICANT" LOCATION
NAME: T&M BUILDING CO.,INCJ 50 LEXIE LANE
ADDRESS: 110 BROOK STREET OWNER T&.M BUILDING CO INC
TORRINGTON,CT;06790 110,BROOK STREET
TORRINGTON,CT 06790
PHONE 860 883 5910
WORK DESCRIPTION: NEW SEWER CONNECTION BUILDING 22 PERMIT FEE COLLECTED ON
APPLICATION 2017.E 755
THE DRAIN LAYER ASSIGNED TO THIS.PERMIT HAS A VAI II?LICENSE ISSLTED BY THE STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORTH`IN TIIE ATTACHED`CONDITIONS'.. AIrL WORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDARDS,ALL OSHA REOUIREIVIENT S,AND THE ATTACHED CONDITIONS.
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ISSUED BY DATE INSPECTED INSPECTED BY
12/7/2017 10:43 AM
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: P ` ., CONTRACTOR:_
LOCATION: d 6—L)i Za 2 a
TYPE OF WORK:, 2 2 c2 x.flii- ('4,09nZ
DATE INSP NEEDED: DATE INSP: f ri 7
INSPECTED BY: 9-1:.)
WORK IN
PROGRESS: 6 404
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SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑YES El NO
AS-BUILT:
INPUT: (',VV DATE: f )-11 f 1'7
S/molloy/forms 2014 town of South Windsor INPSECRON REPORT 14
APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $faa.� e?C
PJIt,;C
Location of proposed work: S, x v Lot # �•-.�
Street No. Street Name
Premises owned by: '
Name of Firm: Phone: <FGc5
Address of Firm: 3C � Z -4' CSC
TYPE OF WORK:
Lay House Drain 4-"� ;Repair House Drain ;
Lay Main ; Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with
Existing Water Supply: Public Water Well
Proposed Start Date zW' T /7 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 ,,ffZa,7/,. the holder of Drain
Layer's License No. dab STTY- P 7 . 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. o20/7 X� / PLEASE NOTE:
IF A.SANITARY SEWER LATERAL
IS WITHIN 75 FEET OF A WELL
IT MUST BE AIR TESTED
Sign Print Name:
Licensed.D3jwCayer
Date: :�,R G / 7
OF
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT,doc
,�10-9 TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS
STREET : Lft�t LAM
SUBDIVISION: u` �+
NORTH ARRO � f/ ILl7) oq
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CONTRACTOR (PRINT) NAM OF R'S SUPERVISOR (PRINT)
STREET ADDRESS StWATURE
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TOWN STATE ZIP INSPECTED BY TOWN
DATE
TELEPHONE NUMBER
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WHITE - TOWN PINK -- CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER
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