HomeMy WebLinkAboutDrain Layers Permits 38 Shepard Way 1800007 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER
DRAIN LAYER PERMIT
DATE: 02/26/2018 `".r
GIS ID: 82600038 r 5;
MUNIS APPLICATION# 201800230 4;�A L �} FEE:
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80.00
x4. ;$ y EXPIRATION DATE: 03/28/2018
APPLICANT' t4
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NAME: ATLANTIC EXCAV . IQN INC
ADDRESS: 363 PARUM ROAD ice` N r ADDRES = 38 SHEPARD WAY
OWNER T&,M$UILDING CO INC
COLCHESTER, CT QG41S j
y 110 BROOK STREET
PHONE S OII�CGTON,CT 06790
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WORK DESCRIPTION: r 4
NEW OWE QNNECTION
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THE DRAIN LAYER ASSIGNED TO TH1§411 E k
IITrII1�S A VA>;iD L�CSE ISSUEI7'BY T fiE STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FOR>H ilk THIAI3TACFIEIy`C4NDTTIpN5' fiML WORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDARDS;Ax.L OSHAQJIREMENI`S,AI�tD TEE ATTACHED CONDITIONS.
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ISSL ED Y 2/26/2018 12:I1 PM
ATE INSPECTED INSPECTED BY
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
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PERMIT NO.: aoccal CONTRACTOR: ea 1lJ I'L
LOCATION:
TYPE OF WORK: boa,, '�a(A2:cr C n kj.c�)c c i o k:�
DATE INSP NEEDED: DATE INSP: lS
INSPECTED BY:
WORK IN
PROGRESS: -,Ivy
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SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES [] NO
AS-BUILT: ' ICE
INPUT: U - DATE:
S/moitoy/forms 2014 Town of South Windsor INPSECRON 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: c7 F S/[e Ora,�ee� Lot # -..%2- 0
Street No. Street Name
Premises owned by:
Name of Firm: Phone:
Address of Firm: -SC,3 P-eu,, C. C%
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 32Y,3�'
Existing Water Supply: Public Water 2--�Well
Proposed Start Date. S 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 � ��,.�`.� c �. r .1:= the holder of Drain
Layer's License No. 42c�gWY- R7 . 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. aZD/�C�65'D/}'�/ PLEASE NOTE:
IF A SANITARY SEWER LATERAL
IS WITHIN 75 FEET OF A WELL
IT MUST BE AIR
//TESTED
Signe Print Name:_
Licensed Drain yer
Date: d1w C r
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT REVISION 2017.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: �' I
BUILDING ADDRESS : d� zo
STREET : 5
SUBDIVISION:
NO TH ARROW
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CONTRACTOR PRINT} NAME OF TRACT�p SUPER (P T)
Lol
S EfT ADDRESS S1G URE
jfj _ J DATE
TOWN STATE ZIP INSPECTED BY TOWN
— � - L DATE
TELEPHONE NUMBER
WHITE — TOWN PINK — CONTRACTOR YELLOW — CONSULTING ENGINEER / DEVELOPER