HomeMy WebLinkAboutDrain Layers Permits 133 Cliffwood Drive (2) 1800036 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 05/29/2018 4
GIS ID:21000133 FEE: 80.00
MUNIS APPLICATION# 201800794 � x EXPIRATION DATE: 06/28/2018
APPLICANT ` w LOCATION
NAME: C&C EXCAVATIONF _ ADDRESS33 CLFFWOOD DRIVE
ADDRESS: 311 WHITE STREET : QN> R ITI�IO JOSEPH D
BRISTOL,CT 06010." '<, { 13J CLIPFWOOD DR
t SQUTH WINDSOR,CT 06074
PHONEUl
WORK DESCRIPTION: DISCOINN>;C^,�"$ANITAIt�t'SEWER HOC1 >r $$ZNG D NxOED
THE DRAIN LAYER ASSIGNED TO THIS PE,;RMITS A VALID I ILEI� $ISSUE? STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FOR WORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDARDS,ALI OSHA'REQCJIREh1ENTS,AND THE ATTACHED CONDITIONS.
ISSUED BY DATE INSPECTED INSPECTED BY
5/29/2018 2:46 PM
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: CONTRACTOR; C CGti �lJ f�/'1
LOCATION: / 471-000�--i
TYPE OF WORK: j.S /° f7 p
DATE INSP NEEDED: DATE INSP:
INSPECTED BY: *a
WORK IN
PROGRESS:
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SEPTIC TANK PUMPED,SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT:
Vmolloy/forms 2014 Town of south windsor INPSEMON REPORT 14
APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVEN U E
SOUTH WINDSOR, CT
FEE $80.00
Location of proposed work: C%4,� i vo () S Lot #
Street No. /Street Name
Premises owned by: Z q C)ee
Name of Firm: �f ol'(f Phone: �—
Address of Firm:
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 ---.F
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 ��an� �� the holder of Drain
Layer's License No. Z,M, 0 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. �U 1 1 " 1.S' PLEASE NOTE:
IF A SANITARY SEWER LATERAL
IS WITHIN 75 FEET OF A WELL
IT MUST BE AIR TESTED
Signed: LPrint Name:
Ljcensed Drain er
Standard Forms\Per fts\APPLICAITON FOR DRAIN LAYERS PERMIT REVISION 3/2018.doc
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SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION:
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STREET : 1 100c) � !`
SUBDIVISION:
NORTH ARROW
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CONTRACTOR (PRINT) NAME OF Cd,TRACTOR'S SUPERVISOR (PRINT)
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STREg ADDRESS SIGNATURE
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TOWN SNTE ZIP INSPECTED BY TOWN
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TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER