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HomeMy WebLinkAboutDrain Layers Permits 21 Farm Hill Road (2) 1800014 TOWN OF SOUTH WINDSOR, CT PERMIT NUMBER DRAIN LAYER PERMIT DATE: 03/28/2018 GIS ID: 31700021 FEE: 80.00 MUNIS APPLICATION# 201800386 , 4 EXPIRATION DATE: 04/27/2018 5 APPLICANfi 4'- 11.,; LOCATION NAME: SSC CONSTRUCTIO*NGLLC ADDRESS - 21 FARM HILL ROAD ADDRESS: 1700 SAYBROOK Roo " OWNI R BOLL LAND XVIII LIMITED PARTNERSHIP MIDDLETOWN,CT 06457° GIB$ALTAR ROAD �IOH M,PA 19044 PHONE J. WORK DESCRIPTION: NEW SEW&Cn© CI'ION THE DRAIN LAYER ASSIGNED TO THIPEI214IITrIAS A yALID LTirI�T,SErSSUED BY EHE STATE AND HEREBY AGREES TO ALL THE THE TERMS AND CONDITIONS SET FOR�'H�,`INt 'A f TACIb�CONDITI01�1 '. A .WORK S HALL BE IN ACCORDANCE WITH THE TOWN OF SOUTH WINDSOR STANDAID�S ALL OSHA RE(CJIRElyN7S,A I T3E ATTACHED CONDITIONS. ............ s die I , - ISSUED BY DATE INSPECTED INSPECTED BY 3/28/2018 3:41 PM 2 t i p sor Hi L .0 ti YY : x a 4 t 11A'SO r TOWN OF SOUTH WINDSOR INSPECTION REPORT PERMIT NO.: /goo CONTRACTOR: Cf OY),S-ktl r�9e7Y1 LOCATION: TYPE OF WORK: Y)Pt s '?mac>,a.�_,r�nersE a DATE INSP NEEDED: DATE INSP: INSPECTED BY: WORK IN PROGRESS: TVA" riir%:li • `'�...�'��L,�.9� Q-`"4'i.tShiC� ��'C?1rti.,fl r�r`4� s % � ��L�G^ryt �/�L�I , 'avJ. SEPTIC TANK PUMPED SMASHED, FILLED WITNESSED ❑YES ❑ NO AS-BUILT. INPUT..—L z ` DATE: `I S/molloy/forms 2014 Town of South Windsor TNPSECftON 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: zZ ��r►h h i '�� Lot # .� Street No. Street Name Premises owned by: Name of Firm: \kC-- Phone: c�,2�r�, Address of Firm: t-7o o 6<-\t brct' E.-7 TYPE OF WORK':/ Lay House Drain > ; Repair House Drain ; Sanitary Disconnect 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 rl Well Proposed Start Date G/, 2, 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 Salk-i�+c— � �� ' the holder of Drain Layer's License No. t?IM O- r-�/ P"7. 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. 20 t 13 O 2 6�4 PLEASE NOTE: IF A SANITARY SEWER LATERAL IS WITHIN 75 FEET OF A WELL IT MUST BE AIR TESTED Signed: Print Name: 80-luk% -G(c—r ".0, f) •fi� Licensed Drain Layer Date: -� . 2 F. f K Standard Form s\Permits\APPLICATION FOR DRAIN LAYERS PERMIT REVISION 3/2018.doc TOWN OF SOUTH WINDSOR SANITARY SEWER LATERAL FIELD LOCATION DATE OF CONSTRUCTION: t ' BUILDING ADDRESS 02 �7(,cwoo k,-t o -A+s STREET VZ S�> SUBDIVISION: s ��.ti . S VJ Se; NORTH ARROW _T_ :Now Ott, - _ +-- �._--�- ► __. - -� _ �_ - r { I _ _ k CONTRACTOR (PRINT) NAME 0 CONTRACTOR'S SUPERVISOR (PRINT) STREET ADDRESS SIN URE TOWN STATE ZIP INSPECTED BY TOWN '660. 250 0 z7.3 �3 DATE TELEPHONE NUMBER WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER