HomeMy WebLinkAboutDrain Layers Permits 82 Lexie Lane 1800028 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 05/02/2018
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GIS ID: 53450082 4 FEE: 0.00
MUNIS APPLICATION# 201800596 �i� ' ��.F EXPIRATION DATE: 06/01/2018
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APPLICANT? �� x {`5 LOCATION
NAME: T&M BUILDING C '1 INCy t M ADDRE S 82 Y.EWLANE
ADDRESS: 110 BROOK STREE �� ONFR 5 hT 8c BUILDING CO INC
TORRINGTON,CTPW70 ' F '`' l I0 BROOK STREET
{ �TUIlGTON,CT 06790
PHONE 860-881 59 I0 v
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WORK DESCRIPTION: NEW SWfI G0 �CTION BLDG 21 L$XTE L1' E1IIT FEE
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THE DRAIN LAYER ASSIGNED TO THI�?.PEr1IT HQ S A� i ID LYCI;NSE.ISSLTIa1h I STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORIkI IhTIE eTTACID`CfONDITIQI�S' ,E1rt L,WORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDAIt1J5,ALL OSIIA REQT1IFtEIvI NTS,AhfiD TIDE ATTACHED CONDITIONS.
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ISSUED BY DATE INSPECTED INSPECTED BY
5/2/2018 2:17 PM
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TOWN OF SOUTH WINDSOR INSPEC OON REPORT
PERMIT NO.:-.1050,E CONTRACTOR:
!.®CATION: 2 C
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TYPE OF WORK: 04-
DATE INSP NEEDED: DATE INSP;_ 5,12
INSPECTED BY:
WORK IN
PROGRESS:
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SEPTIC TANK PUMPED.SMASHED, FILLED W TNESSED ❑YES ❑ NO
AS-BUILT:
INPUT; L DATE:
S/motfoy/forms 2d14 Town of south Windsor YNPSEcnoN REPORT m
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TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $80.00
Location of proposed work: TB Tr BY Z—x>e1.+.Lot # -�
Street No. Street Name
Premises owned by: 7�
Name of Firm: Phone:
Address of Firm: JC ��..�, �Q � � CZ— CC21,4.S' .
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
Existing Water Supply: Public Water ✓ Well
Proposed Start Date 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 . � �_ c A the holder of Drain
Layer's License No. mod* /y 7 . Only holders of P-11 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.recelved
Town Street Excavation Permit No. and/or ConnDOT Permit No.
CBYD No. WOITZ2C PLEASE NOTE:
IF A SANITARY SEWER LATERAL
- IS WITHIN 75 FEET OF A WELL
IT MUST BE AIR TESTED
Signe . Print Name:
Licensed Dr Layer
Date: /
Standard Farms\Perrn(ts\APPLICATION FOR DRAIN LAYERS PERMIT REVISION 2017.dac
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: � �
BUILDING ADDRESS : .. ,, gql
STREET �� �- LIVE
SUBDIVISION: da��
NORTH ARROW
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CONTRACTOR (PRINT) NAME OF CO R'5 S PERVISOR (PRINT)
ST E ODRESS � SIGNATUR
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TOWN STATE ZIP INSPECTED BY TOWN
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DATE
TELE HONE NUMBER
WHITE — TOWN PINK — CONTRACTOR YELLOW — CONSULTING ENGINEER / DEVELOPER