HomeMy WebLinkAboutDrain Layers Permits 1756A Oakland Road 1800019 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 04/10/2018
GIS ID: 65700175 FEE: 80.00
MUNIS APPLICATION# 2018003' EXPIRATION DATE: 05/10/201$
APPLICANT LOCATION
NAME: GERBER CONSTRU ft0N CO AD,DRES5 11sbAkLAND ROAD
ADDRESS: 1 NUTMEG DRIVE ; r OWNER EERY PATCH III LLC
ELLINGTON, CT 06Q29 E {ECUTIVE DRIVE SUITE 100
FtRMIIIGTON,CT 06032
PHONE 860-87S 6684
WORK DESCRIPTION: NEW St CONNECTION FOR BERRY PATGI ICI 5
BUILDING
THE DRAIN LAYER ASSIGNED TO THI S A VALIDTT ENSE ISSUED RYYTHE'STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FOR TH'IN�1HE'ATTACI ED°GQ 11141, 8 A L WbRK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH W INDSOR STANDA�2DS, L OSHA:REQUIRIVFFNi S,AND THE ATTACHED CONDITIONS.
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ISSUED B DA E INSPECTED INSPECTED BY
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: CONTRACTOR: C of r-o rS I(Z-
LOCATION:
- 0.5 '06 IC,laylj ca
TYPE OF WORK: cnn)e
DATE INSP NEEDED: DATE INSP:
INSPECTED BY:
WORK IN
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PROGRESS: Cam ✓ 1 • .� ,. t�2 5'�
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SEPTIC TANK PUMPED,SM. HED, FILLED WITNESSED ❑YES ❑NO-
AS-BUILT:
INPUT: DATE: . t5
S/aidloWorms 2014 Town of South Windsor INPSkUdN 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 S 0--A<LAM o (�A Lot #
Street No. Street Name
Premises owned by: LLC _
Name of Firm: Tl►e /`���� C6,�s � a,., C'0c Phone: Q '7` `19
Address of Firm: xfc���e Lr,�,xg�,. cl- 0603Z
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 Porn co
Existing Water Supply: Public Water ^_ Well
Proposed Start Date . '`/ f e Estimated time for completion I2 3r 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 o,�s ��ct��,. e- the holder of Drain
Layer's License No. o"-o%4y L- i 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 7019 5` 9 PLEASE NOTE:
IF A SANITARY SEWER LATERAL
IS WITHIN 75 FEET OF A WELL
IT MUST BE AIR TESTED
Signed: Print Name: Full,
Licensed Drain Layer
Date: 3 f i Y�'s
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT REVISION 2017.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
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DATE OF CONSTRUCTION: <-i `
BUILDING ADDRESS I -7 5 1& 'D
STREET : 00 (\Q-04
-i- SUBDIVISION: .6-PrY � �
NORTH ARROW
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CONTRACTOR (PRINT) NAME OF CONTRACTOR'S S PERVISOR (PRINT)
STREET ADDRESSADDRESS SIGNATURE
i1f�r�a��C�`� C� 0606 � ^� ATE
TOWN STATE ZIP INSPECTED BY TOWN
'86 a 97S 6 DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER