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HomeMy WebLinkAboutDrain Layers Permit 0169 Avery Street (2) 1800010 TOWN OF SOUTH WINDSOR, CT PERMIT NUMBER DRAIN LAYER PERMIT DATE: 03/15/2018 � GIS ID:06300169 r FEE: 80.00 MUNIS APPLICATION# 201800,303 f EXPIRATION DATE: 04/14/2018 APPLICANT �_"� v ` � 45 �. LOCATION NAME: MOM AND POP PLUMIIQ,&DRAIN ADDRE $ : I6�9}A4ERY STREET ADDRESS: 431 NEWSTATE RCAI �: OW�iER �$00 I'+1EREIDA MANCHESTER,CT06Q4��.- F 1 TtX �AVRY STREET x"` y �0VINDSOR,CT 06074 PHONE 4 y`3 Q+, WORK DESCRIPTION: SANITAIt rt y ISAIR THE DRAIN LAYER ASSIGNED TO THI ER.YII 'HAS A VAF.�D LCNSE ISSUD B TAT STATE AND HEREBY AGREES TO ALL THE TERMS AND CONDITIONS SET FOR'III iN THg ATTACEIEI QNDITIAIS A)�L WORK SHALL BE IN ACCORDANCE WITH THE TOWN OF SOUTH WINDSOR STANDARp^�,{ IL?OSHA 12EQtJIItME1�1A�VD jFTEATTACHED CONDITIONS. ISSUED BY DATE INSPECTED INSPECTED BY 3/15/2018 3:49 PM F � R � Syr 4 � y �k FS 5,' s fi e C h p Sa i. WT Af 0011 ?�uyh lb Ig rgya i `Yi � F5 cL TOWN OF SOUTH WINDSOR INSPECTION REPORT PERMIT NO.: 1A0010 CONTRACTOR:- Ina h'? Q- J�q LOCATION: TYPE OF WORK:(l , ±2212! Ii2m /2 DATE INSP NEEDED: DATE INSP: INSPECTED BY: WORK IN PROGRESS: SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑YES ❑ NO AS-BUILT: ' INPUT: - DATE: S/malloy/forms 2014 Town of South Windsor mpsa m REPORT 14 APPLICATION FOR DRAIN LAYER PERMIT TOWN OF SOUTH WINDSOR PUBLIC WORKS DEPARTMENT TOWN HALL 1540 SULLIVAN AVENUE SOUTH WINDSOR, CT FEE $80.00 Location of proposed work: 1 e'r S+ Lot #_ Street No. Street Name Premises owned :b .- Y Name of Firm: �a1A Phone: 6d - S �� Address of Firm:_ 31 TYPE OF WORK: Lay House Drain ; Repair House Drain ; Lay Lateral for building with connection ; or no connection ; Lay Main Lay Lateral for Commercial/Industrial Building number of acres Connection Will be made with s:S 1) L Existing Water Supply: Public Water Well Proposed Start Date 3 1510rlstimated time for completion e-t ALL WORK TO BE IN ACCORDANCE WITH TOWN OF SOUTH WINDSOR STANDARDS, ALL OSHA REQUIREMENTS AND CONDITIONS ATTACHED TO THE PERMIT Permit is to be issued to Pe4e- r Z u the holder of Drain Layer's License No. ©S' �PI Onlf holders of P-1, P-7 or W-9 licenses will be Issued a permit. PERMIT WILL EXPIRE THIRTY (30) DAYS AFTER DATE OF ISSUANCE. The undersigned Drain Layer hereby agrees to all the terms and conditions set forth in the permit and attached thereto. Applicant has received Town Street Excavation Permit No. and/or ConnDOT Permit No. CBYD.No. ti o l l,z�3 5� PLEASE NOTE: ^ IF A SANITARY SEWER LATERAL IS WITHIN 75 FEET OF A WELL IT MUST BE AIR TESTED Signed: t Name:__ � r �w� Lice ed rain Layer Date; 5� standard Forms\Permit5\APPLICATION FOR DRAIN LAYERS PERMIT REVISION 2017,doc TOWN OF SOUTH WINDSOR SANITARY SEWER LATERAL FIELD LOCATION DATE OF CONSTRUCTION: BUILDING ADDRESS : * _ +� STREET : SUBDIVISION: NORTH ARROW { f I _ , •i'" 4—— � �—. __ __ _ _ — -a Itiu I ► 1� L._. --. CONTRACTOR (PRINT) NAME OF CPNTRACTOR'S 5LIR� t$�QR.:.-(-PRINq,) STREET ADDRESS SIGNATURE IL4� .GFt�'Gc `At.d— s` JD ATE TOWN STATE ZIP INSPECTED BY TOWN '&)c gx)iQ-1-- DATE TELEPHONE NUMBER WHITE — TOWN PINK — CONTRACTOR YELLOW — CONSULTING ENGINEER / DEVELOPER