HomeMy WebLinkAboutDrain Layers Permits 54 Lexie Lane 1700075 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
n.
DATE: 12/07/2017
GIS ID: 53450054 FEE: 0.00
MUNIS APPLICATION# 201701760 EXPIRATION DATE: 01/06/2018
APPLICANT LOCATION
NAME: ATLANTIC EXCAVATION INC ADDRESS: 54 T.EXIE LANE
ADDRESS: 363 PARUM ROAD OWNER T&M BUILDING CO INC
COLCHES.TER,CT 06415 110:BROOK STREET
FORRINGTON,CT 06790
PHONE
WORK DESCRIPTION: NEW SEWER CONNECTION FOR'BUILDING 22
THE DRAIN LAYER ASSIGNED TO THIS PERMIT HAS A VALID LICENSE ISSUED BY 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 STANDARDS,ALL OSHA'RIQUIREMEN TS,AND THE ATTACHED CONDITIONS.
All)
ISSUED BY DATE INSPECTED INSPECTED BY
12/7/2017 12:04 PM
k
3 -
1
TOWN OF SOUTH WINDSOR INSPECTION REPORT
r
PERMIT NO.:.� CONTRACTOR:
LOCATION: ro LV 262 /
TYPE OF WORK: D
DATE INSP NEEDED: DATE INSP: �'l 7
INSPECTED BY: It,)
WORK IN
PROGRESS: 6 ' 5,b rz 9L in-,
C ept5
i
G
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: _ ��`-' DATE: / 2,
S/molloy/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 $WG0 60,
Location of proposed work: �? ' -s 2 ' Lot # .�•��R-
Street No. Street Name
Premises owned by:
Name of Firm: 7:r�t .fir Phone: !RC� - //7C
Address of Firm:
TYPE OF WORK:
Lay House Drain ~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 IRIV17 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 X-&�..71,c Ex the holder of Drain
Layer's License No.02a 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. 2017 Zgj ? l Xrl PLEASE NOTE:
IF A SANITARY SEWER LATERAL
IS WITHIN 75 FEET OF A WELL
IT MUST BE AIR TESTED
Sign Print Name: Zj
Licensed Drai aver
Date: ZRAC�f 7 --
Standard Forms\Permits\APPLICAn0N FOR DRAIN LAYERS PERMIT.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: �l " 11,o
BUILDING ADDRESS
STREET
SUBDIVISION:
nARRO NORTH IL tLl7 oq (14
0 .0
4
Ilk
O
l
1
CONTRACTOR (PRINT) NAM OF R'S SUPERVISOR (PRINT)
3623-
to
4
STREET�ADaDRESS STWATURE
DATE
TOWN STATE ZIP INSPECTED BY TOWN
DATE
aim
TELEPHONE NUMBER—�
WHITE - TOWN PINK - CONTRACTOR YELLOW -- CONSULTING ENGINEER / DEVELOPER