HomeMy WebLinkAboutDrain Layers Permits 1756B Oakland Road 1800020 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 04/10/2018 "
GIS ID:65700175 FEE: 80.00
MUNIS APPLICATION# 201800379 k t EXPIRATION DATE: 05/10/2018
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APPLICANT " -' LOCATION
NAME: GERBER CONSTRU TIfJN CO ADDRIfSS ...... I75 OjUCLAND ROAD
ADDRESS: 1 NUTMEG DRIVE �} OWNER $ R1Y PATCH III LLC
ELLINGTON,CT 002 6 EXECITTIVE DRIVE SUITE 100
EXIO NGTON,CT 06032
PHONEWgg
860-87 6684
WORK DESCRIPTION: NEW SE mAl,' I ITr
BUILDIN (6B)b09 616
THE DRAIN LAYER ASSIGNED TO THOVEk-Ulf,HAS A VALID LICENSE ISSUED BY THE'STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORTH'TN TH1`A-TFXCHED.`.CONDITIONS':::ALL WORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDAID�,A L OSHA REQY�IRI;MEN S,A�1D TfTE ATTACHED CONDITIONS.
ISSUED BY DATE INSPECTED INSPECTED BY
4/10/2018 12:26 PM
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: - 6'i ? . CONTRACTOR:
LOCATION:
TYPE OF VVORK: CDrr�G�-io
DATE INSP NEEDED: DATE INlSP:-,yS -/Z/-i:f
INSPECTED BY:
WORK IN
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SEPTIC TANK PUMPED,5 W, FILLECL .. WITNESSED ❑YES ❑ NO'
AS-BUILT:
INPUT: (i DATE:
S/moRoygarrns 21114 Town of South Windsor Mpsi oN REPbru m
mrruum i 1viN rVK UKAm LIATCK I'CKI"I!I
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $80.00
Location of proposed work: 05" 614<LAal-) Lot # E CD 6
Street No. Street Name
Premises owned by.---P,
Name of Firm: lh Adr C'4,�s �zd��.� C'or P Phone: '�6-0 7
Address of Firm: f1tfW,rVI ca 4t 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 Funs co
Existing Water Supply: Public Water Well
Proposed Start Date Estimated time for completion . 12131 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 � �� 0;%-JvL ?^ � the holder of Drain
Layer's License No. O-Lotjsj.@ �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, �b 7019 5' `91 _ PLEASE NOTE:
IF A SANITARY SEWER LATERAL
IS WITHIN 75 FEET OF A WELL
IT MUST BE AIR TESTED
Signed: Print Name: 90e,
Licensed Drain Layer
Date: 3
Standard Forms\Permits�APPLICATION FOR DRAIN LAYERS PERMIT REVISION 2017.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: A. - __
BUILDING ADDRESS : z _75-
STREET : 4 4 --d
SUBDIVISION: �e r
NORTH ARROW
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CONTRACTOR (PRINT) NAME =NTRACTOR'SR (PRINT)
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STREET ADDRES SIGNATURE
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TOWN ___ __ __.. __ STATE ZIP INSPECTED BY TOWN -
�[,,� -�75" ��iS� DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER