HomeMy WebLinkAboutDrain Layers Permits 78 Longmeadow Drive (2) 1800037 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 05/31/2018
GIS ID: 54670078 r 5 4 ti
FEE: 80.00
MUNIS APPLICATION# 201800810r`'� ytsl14 EXPIRATION DATE: 06/30/2018
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APPLICAN u h LOCATION
NAME: SSC CONSTRUCTIOI' pup a tt` a rat ADDRES�S� ' litONk MEADOW DRIVE
ADDRESS: 1700 SAYBROOK R( A f i i +QTE 4 as TOIL I AND XVIII LIMITED PARTNERSHIP
MIDDLETOWN,CTP640 2 ?GIBI�ALTAR ROAD
jf PA 19044
PHONE
WORK DESCRIPTION: NEW SAWR COI II CTrt�N a � N
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Q�S ti- }� yqY?�N' �,.,a iy�� •«�'v��.� M � R �� t 1�4.`�• vQ THE DRAIN LAYER ASSIGNED TO THI4� ER IT I AS A A}TI I{� st SSU I Br� IH .STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORT I IN T�II STTA HIiII ;CZ�I�ITIQN 3J ALA�1 >'RK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH.WINDSOR STANDA S;44p OS REQC1I1t IvI S;. t TT E ATTACHED CONDITIONS.
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: 0003 ? CONTRACTOR: SSC,
LOCATION: ra n a Fri n t r J V C
TYPE OF WORK: ��' ����( (;� �h�°�-�.� Tdd,
DATE INSP NEEDED: _DXTE_IRSP: C /fit
INSPECTED BY: 6
WORK IN
PROGRESS: CKyci�,.' � ,��'� �� ��" r✓�,,�
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.SEPTIC TANK PUMPED,SMASHED, FILLED WITNESSED ❑ YES [] NO
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SJmolioy/forms 2014 Town of South Windsor INPSEcn(jN REPORT m
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: (a n�Meade,L✓ Z)a. Lot # 3 3
Street No. Street Name
Premises owned by: —Co t` 3 Cos. -3,n
Name of Firm: SS C eon S• r,)CA t'a,r\ 1 t L Phone: • 0yo. 2 3 + 3
Address of Firm: t 7do 54zV 6root-%12 C�) M,deJLP-1&w,-\. i
TYPE OF WORK:
Lay House Drain , Repair House Drain ; Sanitary Disconnect
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 so t2
Existing Water Supply: Public Water ><- r Well
Proposed Start Date 6 _ t 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 6a1v�}e,�(fcf."n•-�-® the holder of Drain
Layer's License No. U\m .oZ8 7fgi p--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. Zo(r 2 20 Z ZQc,, PLEASE NOTE:
IF A SANITARY SEWER LATERAL
IS WITHIN 7S FEET OF A WELL
IT MUST BE AIR TESTED .
Signed: Print Name: S��v�,1�.�`� ,�.� `n• fi
Licensed Drain Layer
Date: 3 t
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT REVISION 3/2016.doc
TOWN OF SOUTH WINDSOR
-SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: ' �" 3
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BUILDING ADDRESS 7,: c;' JC�v
STREET
SUBDIVISION: 1 �
NORTH ARROW
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CONTRACTOR (PRINT) �� NAME OF TRACTOR'S SUPERVISOR (PRINT)
STREET ADDRESS SIGNATURE
h1l� � (.'r 0(C45 + `.. "DATE
TOWN STATE ZIP INSPECTED BY TOWN
Zi-0 7✓ C1' G DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER