HomeMy WebLinkAbout175 Oakland Rd - Drain Layer Permit - Bldg 3 1800017 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE.
. 04/I0/201 8
....... ... :..
GIS ID: 65700175 FEE: 80,00
MUNIS APPLICATION# 201800372 EXPIRATION DATE: 05/10/2018
APPLICANT LOCATION
NAME: GERBER CONSTRUTLC3N:CQ: ADDRESS L7 0�4TCLAND ROAD
ADDRESS: 1 NUTMEG DRIVE ? OWNER BERRY PATCH III LLC
ELLINGTON,CT 06bli;_` 6 EXECCTTIVE DRIVE SUITE 100
AIII :GTON,CT 06032
PHONE 860 875r6684
WORK DESCRIPTION: NEW SIB WF`'R gOwECTION FOR BERRY"PATCH III
BUILDING(3)301 3t Y `
THE DRAIN LAYER ASSIGNED TO THIS�.�?EIIMI1 HA5 A VALID LICENSI ISSUED BY`TII STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORTII IN THE TTACIIED`1 C)NDITIQNS AL L Vl70RK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STAND AIIS AI, L OSIIA"RBQUIRI;MENI S,AND THE ATTACHED CONDITIONS.
ISSUED BY DAT8 INSPECTED INSPECTED BY
4/10/2018 12:09 PM
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.:- .f 000 N`7. _ CONTRACTOR: 4fabPE L ►�s`�7Z.. _
LOCATION: -Q.
TYPE OF WORK.
DATE INSP NEEDED: DATE INSP: ' �
INSPECTED BY: 8
WORK IN
PROGRESS:
SEPTIC TANK PUMPED,5 HED, FILLED, WITNESSED ❑YES ❑NO-
AS-BUILT:
INPUT: G YV` DATE; i
5/mofloy(Forms 2014 Town of South Windsor INPSitadN REPORT 14
APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE �� _
SOUTH WINDSOR, CT
FEE $80.00
Location of proposed work: i-7 57 oA<+-AJV n R� Lot # g D#3
Street No. Street Name
Premises owned by: Re rr Nk t,
Name of Firm; Ve � U C'�„5 ,,�dro� Car P Phone: S'60 67 9k
Address of Firm: C_ _&xec,�vt rA , C-T 06032
TYPE OF WORK:
Lay House Drain ; Repair House Drain ;
Lay lateral for building with connection; or no connection ;
Lay Main
Lay Lateral for Commercial/Industrial Building number of acres
Connection will be made with Forn co
Existing Water Supply: Public Water Well
Proposed Start Date 1'� i$ Estimated time for completion I'll3r lie
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 1 r6,ev, ("0,s�(vAo^ ---P1vc- the holder of Drain
Layer's License No. O-Lo s; - �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 I�b 70 19 S PLEASE NOTE:
IF A SANITARY SEWER LATERAL
IS WITHIN 75 FEET OF A WELL
IT MUST BE AIR TESTED
Signed: Print Name: Ful^
Licensed Drain Layer
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 i - o r n
BUILDING ADDRESS I�� ` k1���►�a
STREET .
SUBDIVISION: ��
NORTH ARROW
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CONTRACTOR (PRINT) NAME OF CONTRAC OR'S SUPERVIS R (PRINT)
STREET ADDRESS SIGNATURE
t 11ttic to v\ o-+ C)b01 og �- "D TE
TOWN Y STATE ZIP INSPECTED BY TOWN
c,C DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER