HomeMy WebLinkAboutDrain Layers Permits 43 Shepard Way 1800004 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 01/29/2018 t '_
r S FEE: 80.00
GIS ID: 82600043 ,
MUNIS APPLICATION# 201800114EXPIRATION DATE: 02/28/2018
APPLICANT 5 x 4
T z LOCATION
NAME: ATLANTIC EXCAVATION INC ADDRE E 43 SHI~,PARD WAY
ADDRESS: 363 PARUM ROAD !, r O WI�TI✓R BUILDING CO INC
COLCHESTER,CT 064 310 BRaOK STREET
4 z y t F
PHONE 4 TQR)IIGTON,CT 06790
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WORK DESCRIPTION: NEW S) WI �O1CTItSN 4 k ] { l
THE DRAIN LAYER ASSIGNED TO THISSPEIZMIT HAS A Vx4L Ib L�CEN'SE ISSi�FED .THIr STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORT I�IV.THE ATE AGED`CC?IrIDI`I'ZO�T,S' : `LL,306RK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDA1tD5�AL]OSHA REQL7IRE1VIIjNTS,AND THE ATTACHED CONDITIONS.
ISSUED BY DATE INSPECTED INSPECTED BY
1/29/2018 11:50 AM
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: 180000 CONTRACTOR:
LOCATION: q3 She 0129,4 1,��_� ► - ----
TYPE OF WORK: e o vi r►
DATE INSP NEEDED: DATE INSP:
INSPECTED BY: Cib
WORK IN
PROGRESS: �d� ✓� � ; s ,� '' ��. s'D 3 �,�.
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SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES [-] NO
AS-BUILT:
INPUT: L4A
DATE:•
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5/molloy/forms 2014 Town of south wlndsor INKS crm 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: Lotak
Street No. Street Name
Premises owned by: ,
Name of Firm: 7/w-T � at �,.�_ Phone: '���,� //7�'
Address of Firm:_ 3 arm _„ � �f�7=� <: Z.- c2c- �lS
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
Existing Water Supply: Public Water Well
Proposed Start Date S'' Estimated time for completion
i
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. ?Tr P? . 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. a5�0/F L5,LO �S/ We PLEASE NOTE:
IF A SANITARY SEWER LATERAL
IS WITHIN 75 FEET OF A WELL
IT MUST BE AIR TESTED
Signe . Print Name: /�
Licensed Drorrfayer
Date:
Standard Forms\Permlts\APPLICATION FOR DRAIN LAYERS PERMIT REVISION 2017.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: I "
BUILDING ADDRESS
STREET
SUBDIVISION:
NORTH ARROW
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CONTRACTOR (PRT) NAM OF CONftCTOR'l SUPERVISOR (PRINT)
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STREET ADDRESS SI ATURE
Z _,DATE
TOWN STATE ZIP INSPECTED BY TOWN
a v[_!V DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER