HomeMy WebLinkAboutDrain Layers Permits 48 Patria Road (2) 1800001 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 01/18/2018 A40
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GIS ID:69900048 FEE: 80.00
MUNIS APPLICATION# 201800079 nr .`s EXPIRATION DATE: 02/17/2018
APPLIT LOCATION
NAME: SKIPS WASTEWATF;I� F ADDRESSBPA ROAD
ADDRESS: 21 COURTNEY DRI`J)i ; 5 OWNER FORTY IGHT PATRIA ROAD ASSOCIATES
ELLINGTON,CT 06 29 5, 9 PATINA ROAD
;' S a (�LITIVINDSOR,CT 06074
PHONE 860 87 2D2
WORK DESCRIPTION: INSTAL�L�,�CI�ASE TRAP& "NEW CC}NNEC`P��N,_A��'ART'OF BUILDING
ADDITIQFOR�DISIN TIE TREE SERVICl� c�
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THE DRAIN LAYER ASSIGNED TO THIS"PEIMI1'IIA STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORIV I&ATTACII] I `4"I7NDITIONS .AFL wORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDARDS,E4LL OSHA REQUIREMENT S,Ai�iD TIDE ATTACHED CONDITIONS.
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ISSUED BY DATE INSPECTED INSPECTED BY�
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: Q CONTRACTOR:
LOCATION: �8 TL 1 GL &1d
TYPE OF WORK: i M ,-, &aIla
DATE INSP NEEDED: DATE INSP: IA 118
INSPECTED BY: 60
WORK IN
PROGRESS: ,)vn-e'A'— Al
2215
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SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: tM- DATE: J~,)3-J a',
S/molloy/forms 2014 Town of South Windsor INPSECTION 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:_ 4y ? e 7Zon�i) Lot #
Street No. Street Name
Premises owned by: '2>I5-r7 tX t'J �1-
Name of Firm: 1J&'7;r eJ&I-Z I Phone: Sla d 47s 12 3 3 2.
Address of Firm: 2-1 C01.r217U'�y (P1r- -rnj(n r� nj
TYPE OF WORK:.
Lay House Drain Repa' House Drain ;
�k f S 77 J fi �lF7Tc I[R�
Lay Lateral for building with connection ; or no connection ;
Lay Main
Lay Lateral for Commercial/Industrial Building number of acres
? Ep
Connection will be made with S" z- .�.�
Existing Water Supply: Public Water >( Well
Proposed Start Date i3 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 -7al-i Z041--k f /-C- the holder of Drain
Layer's License No. o 7 o 2'7 2- ! . 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. .2o<'7 4-'`® 4-7 2 4- PLEASE NOTE:
IF A SANITARY SEWER LATERAL
IS WITHIN 75 FEET OF A WELL
IT MUST BE AIR TESTED
Signed: Print Name: �/ 5
Li ensed Drain Layer
Date: � ��17
Standard Farms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT REVISION 2017.dac
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: Ply .Q - ---
BUILDING ADDRESS
STREET : 67 1 04,n
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-� SUBDIVISION:
NORTH ARROW
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CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPERVISOR (PRINT)
L-Cwel'7�ey .
STREET ADDRESS / SIGNATURE
DATE
TOWN STATE ZIP INSPECTED BY TOWN
560 971_ -7-416
DATE
TELEPHONE NUMBER
WHITE - TOWN PINK -CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER