HomeMy WebLinkAboutDrain Layers Permits 86bldg 21 Lexie Lan 1800030 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 05/02/2018
GIS ID: 53450086 F i' �k FEE: 0.00
MUNIS APPLICATION# 201800600 , r
. 4 EXPIRATION DATE: 06/01/2018
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APPLICAI1iI �;tr _ _ wja LOCATION
NAME: T&M BUILDING CQ� 1Cr5 �1DDRES $6 1 EJIE LANE
ADDRESS: 110 BROOK STREET ` } ONEXt a t!T&M BUILDING CO INC
TORRINGTON, CT1�7<9� 1�O BROOK STREET
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PHONE 860-883k 590 I E rK
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WORK DESCRIPTION: NEW Si G� IfCTrbNyBLDCr 2`1 LI; �SE�1.QIB PRMIT FEE
COLLE0D 0I4 A4B
THE DRAIN LAYER ASSIGNED TO THIS° EI IVI IT H S LIC);NS ISs[I BY'.-THE STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FOItII TNHAfiT'ACTD' ()I*TDITIONS',AFL WORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDAS,AItL t3SI?�i RE(I)IREMEIrI S4 A1n FIE ATTACHED CONDITIONS.
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ISSUED BY DATE INSPECTED INSPECTED BY
5/2/2018 2:26 PM
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TOWN:
OWN OF SOUTH:WINDSOR INSPECTION REPORT
P CDNT"RACTOR:ERMIT NO.:
LOCATION:- Mdo
TYPE OF WORK:
DDkTE'INSP NEEDED. DATE INSP:
INSPECTED BY.._.
WORK IN
PROGRESS: "w '° if V
SEPTIC TANK. PUMP . .,5MASHED, WITNESSED ❑ YES ❑ NO
AS-BUILT:. -.
INPUT:
R
S/Molloy/fbrms 2014 Town of South WMdsor INPSEC'ROIV REPO a 14
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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: 7,4- � 8�2 r><<.+.Lot #
Street No. Street Name
Premises owned by:
Name of Firm: Phone: �P-�3��/�7�
Address of Firm: �.��?Z,� %. c Zkr
TYPE OF WORK:.
Lay House Drain r/ ; 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
Existin9 Supply:Water.Su i : 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 the holder of Drain
Layer's License No. k•R7 - 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.recelved
Town Street Excavation Permit No. and/or ConnDOT Permit No.
CBYD No. _���` /,�.3��` PLEASE NOTE:
IF A SANITARY SEWER LATERAL
IS WITHIN 75 FEET OF A WELL
IT MUST BE AIR TESTED
Signe Print Name:__ Za a/
Licensed Dr Layer
Date:
Standard Forms\Perm1ts\APPUCATION FOR DRAIN LAYERS PERMIT REVISION 2017.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: �'z
BUILDING ADDRESS sz
STREET LIVEL
SUB DIVISION:
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NORTH ARROW
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CONTRACTOR (PRINT) NAME OF CO R'S S PERViSOR (PRINT)
S3TPEV DDRESS SIGNATURE
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TOWN STATE ZIP INSPECTED BY TOWN
DATE
TELE HONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER