HomeMy WebLinkAboutDrain Layers Permits 35 Woodside Drive 1700078 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 12/20/2017
GIS ID:97500035 FEE: 80.00
MUNIS APPLICATION# 201701855 Y i EXPIRATION DATE' 01/19/2018
APPLICANT _ LOCATION
NAME: SKIPS WASTEWAT5Py. ADDRES 35 WOpDSIDE DRIVE
ADDRESS: 21 COURTNEY DRIVFt" i IA LOUIS W
ELLINGTON, CT 0609 r5 `WO DSIDE DRIVE
r; EOUH WINDSOR,CT 06074
PHONE 860 87 2M7'tt
WORK DESCRIPTION: NEW SEW CONNECTTO1�f
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THE DRAIN LAYER ASSIGNED TO THIS�$RMI HAS A VALTDiLICENrISS[J>JASY•TH STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORT 'III HE',ATTACHI;D` 1*1D131O1 ' , i'L WORK SHALL BE IN ACCORDANCE WITH
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THE TOWN OF SOUTH WINDSOR STAND ARDS, i L OSHA REQUIREMEj�(TS,ANri r1E ATTACHED CONDITIONS.
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ISSUED BY DATE INSPECTED IN ECTED BY
12/20/2017 3:18 PM
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: L06 7 CONTRACTOR:-
LOCATION: S 5-
TYPE OF WORK:
DATE INSP NEEDED: DATE INSP:
INSPECTED BY:
WORK IN
PROGRESS: S G5��; t'h� �lt (•'r yc
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED YES ❑ NO
AS-BUILT:
INPUT: DATE:
S/moNoy/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: Lot #
Street No. Street Name
Premises owned by: /a k G u r i
Name of Firm: 5, rPs IV 1?-5"7—c 0 4 77 77-- Phone: 9:�o - $? S 33 �-
Address of Firm: 2 k l nJ G 7-P Al
TYPE OF WORK:.
Lay House Drain ; Repair House Drain ;
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 s n_ P VC-
Existing Water Supply: Public Water x Well
C�rc-e-
Proposed Start DateL 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. o,2 o ? '7z . 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. ,2 o l 7 G ° �—? PLEASE NOTE,
IF A SANITARY SEWER LATERAL
IS WITHIN 75 FEET OF A WELL
IT MUST BE AIR TESTED
Signe Print Name:
Alcensed Drain Layer
Date: 1 z /-- ,7
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT REVISION 2017.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: , 7
BUILDING ADDRESS 35
STREET : W00LS r ;✓e- -- -. -.
SUBDIVISION:
NORTH ARROW
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CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPERVISOR (PRINT)
STREET ADDRESS SIGNATURE
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����.�� � L �> •ASS �� ���I !i 7 DATE --.
TOWN STATE ZIP INSPECTED BY TOWN '
�0— 0-71 DATE
TELEPHONE NUMBER
WHITE — TOWN PINK — CONTRACTOR YELLOW — CONSULTING ENGINEER / DEVELOPER