HomeMy WebLinkAboutDrain Layers Permit 03 Barbara Road 1800006 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER
DRAIN LAYER PERMIT
DATE: 02/09/20I8
GIS ID: 07500003 ,F
MUNIS APPLICATION# 201800166 sr4 wj - i FEE: 80.00
i k sk EXPIRATION DATE: 03/11/2018
APPLICANT w2 S r 4 4 A
NAME: JAMES THROWS DBA LOCATION '`
ADDRESS: 1330 MAIN STREETS � ; j' ADDRESS' 3 BAR$ARA ROAD
�"` �'U NER - �&AJA DANIEL E&JENNIFER A
SOUTH WINDSOR,CT.06g74 E
x 3 BARB(1RA ROAD
PHONE 860-28g'Od9S 5 r �� OIJTH WINDSOR,CT 06074
WORK DESCRIPTION: NEW h y
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THE DRAIN LAYER ASSIGNED TO TFOldE ' 1IT HAS�l�I ,II Z IC NSI✓ SSU DEBT'T STATE AND HERESY AGREES TO ALL
THE TERMS AND CONDITIONS SET FOR ' IN�'HEA�ITACIII;b`CONDITIONS' Wpm{SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDATS A L OSIJA RE(UIRMI,NO ANb TFiE ATTACHED CONDITIONS.
ISSU D BY E SPECTED ��
2i9i201810:08 AM INSPECTED BY
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.:_ QQ CONTRACTOR: To,vn e .,.-
LOCATION: Cti� � jZ
TYPE OF WORK:DATE INSP NEEDED: DATE INSP: y
INSPECTED BY: 60
WORK IN
PROGRESS: ,,,.
SEPTIC TANK PUMPED, SMASHED, FILLED L WITNESSED Q YES NO
AS-BUILT:
INPUT: r'V .- DATE: 7
S/Molloy/forms 2014 Town of South Windsor INPSECrm REPORT m
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: J e= �� Lot #
Street No. Street Name
Premises owned by:
Name of Firm: U6n f �rL �eN 1� Phone:k Z G4
Address of Firm: M(Uv') s
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 3
Existing Water Supply: Public Water Well
Proposed Start Date J3 F 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 , 1L LNti-�- ., the holder of Drain
Layer's License No. ;L-j boS . 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. OI PLEASE NOTE:
IF A SANITARY SEWER LATERAL
IS WITHIN 75 FEET OF A WELL
IT MUST BE AIR TESTED
Signed: 11L Print Name: J amg's
Licensed Drain Layer
Date.
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT REVISION 2017,doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: 1 Ile
BUILDING ADDRESS
STREET
SUBDIVISION:
NORTH'ARROW
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Al-
71
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CONTRACTOR (PRINT) NAME OF CONTRACTOR'S UPERVISOR (PRINT)
133c) L==�
STREET ADDRESS SIG61URE
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TOWN STATE ZIP INSPECTED BY TOWN
0 66 DATE -
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER