HomeMy WebLinkAboutDrain Layers Permits 58 Lexie Lane 1.700076 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 12/07/2017
GIS ID;53450058
FEE:
.00
MUNIS APPLICATION# 201701762 EXPIRATION DATE: 01/06/2018
APPLICANT LOCATION
NAME: ATLANTIC EXCAVATION INC_ ADDRESS: 58 LEXIE LANE
ADDRESS: 363 PARUM ROAD OWNER; T,&,M BUILDING CO INC
COLCHESTER, CT 06415 ' 110 BROOK STREET
TORRINGTON,CT 06790
PHONE ;
WORK DESCRIPTION: NEW SEWER CONNECTION BUILDING 22
THE DRAIN LAYER ASSIGNED TO THIS PERMIT HAS A VALID LICENSE ISSUED EY THE'STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORTH IN THE ATTACHED`CONDITIONS' ALL WORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDAkDS,ALL OSHA REQUIREMENTS,AND THE ATTACHED CONDITIONS.
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ISSUED BY DATE INSPECTED INSPECTED BY
12/7/2017 12:14 PM
TOWN OF SOUTH WINDSOR INSPECTION REPORT
r
PERMIT NO.: CONTRACTOR:—
LOCATION: U /
TYPE OF WORK: Leu)
DATE INSP NEEDED: DATE INSP:
INSPECTED BY: } )
WORK IN
PROGRESS: Vc- SnrL L' iiz-, 'JL b 04 "p-
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: DATE: 1 1+j
S/molloy/forms tom Town of South Wlndsor TNPSECrTON REPORT 14
APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $.6� 60,
Location of proposed work: S�_ 5�-rG.7 Lot # .�• � �
Street No. Street Name
Premises owned by:
Name of Firm: Phone:
Address of Firm: 3C3 e-j—
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 IR T /? 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 X74 ,74, -Z�c the holder of Drain
Layer's License No. a2c5 SyyY- y 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. o2017 Y, e> ZXrl PLEASE NOTE:
IF A SANITARY SEWER LATERAL
IS WITHIN 75 FEET OF A WELL
IT MUST BE AIR TESTED
Sign Print Name:
Licensed D5[p,6ayer
Date: fog G / -7
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc
�,�•``� TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS : z 69 54 6
STREET
SUBDIVISION: _uiAn Nr
NORTH ARRO � � CILJ�) (1q7) 64
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CONTRACTOR (PRINT} NAM OF R'S SUPERVISOR (PRINT)
3623
STREET ADDRESS StWATURE
ATE
TOWN STATE ZIP INSPECTED BY TOWN
DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER