HomeMy WebLinkAboutDrain Layers Permits 221 Pepin Place 1800044 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
S ,
DATE: 06/05/2018 5
GIS ID: 70700221 FEE: 0.00
MUNIS APPLICATION# 201800860 vrf`n3r r s EXPIRATION DATE: 07/05/2018
APPLICANt LOCATION
NAME: ATLANTIC EXCAV* QT�NC44 Y ,., x Y ADDRE r` 2I 'ET?IV PLACE
ADDRESS: 363 PARUM ROAD BJILDING CO INC
COLCHESTER, CT d" W, t z t fi `' x 4 I�fO BROOK STREET
RR,N' TON,CT 06790
PHONE }
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WORK DESCRIPTION: NEWS vER C'01 T Oi I+OR BUIL' U �O CJ 7I '1TDSOR WOODS
PERMIT CCILIOPD 4TQ105 `ter5
THE DRAIN LAYER ASSIGNED TO THISEIIIT HAS AN ISSU,E NTATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORTK IN'I;H ,"', - Io- K.0 }AFL 4- RK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STAND
AR ;9Ir a�a1IA RE�iJREIuIET'�,Al TATTACHED CONDITIONS.
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ISSUED BY DATE INSPECTED INSPECTED BY
6/5/2018 11:05 AM
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TOWN, OF SOUTH WINDSOR INSPEC710M REPORT
PERMIT NO.., . goo -VY CONTRAMRo
LQCATIONe -v n l
TYPE OF WORK:. . Y)f r Pe��.`
DATE INSP NEEDED: DATE INSP:
INSPECTED BY.-
WORK IN
PROGRESS:
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SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ® YES NO
AS-BUILTn
INPUT: -' DATE o : --6- 2 1
S/molioy/forms 2014 Town of South Windsor TfVPSEM614 REPORT 14
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:, .Loth
Street No. Street Name
Premises owned by:
Name of Firm: � �; � f� Phane� �--U
Address of Firm: �Z 3 'a '
TYPE OF WORK.-
Lay House Drain 4---';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 s Well
Proposed Start Date& Estimated time for completion c
ALL WORK TO BE IN ACCORDANCE WITH TOWN OF SOUTH WINDSOR STANDARDS,
ALL OSHA REQUIREMENT'S AND CONDITIONS ATTACHED TO THE PERMIT
Permit is to be issued to ; the holder of®rain
Layer's License No. g„y— 77 . 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. PLEASE NOTE.
IF A SANITARY SEWER LATERAL
IS WITHIN 75 FEET OF A WELL
IT MUSS' BE AIR TESTED
Signed: � Print Name: �.� V
Licensed Drain jzyer
Date.
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT REVISION 2017.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS
STREET : Z0 �K 109 ,1K,2rlu ' '
SUBDIVISION:
NORTH ARROW ' ® * �� 711
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CONTRACTOR (PRINT) NAME OF CO T R'S SUPERVISOR (PRINT)
-50 ycja�
ST EET ADDRESS SIGNATURE
TOWN STATE ZIP INSPECTED BY TOWN
u -!tl � DATE
TELEPHONE NUMBER
WHITE -- TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER