HomeMy WebLinkAboutDrain Layers Permits 215 Pepin Place 1800045 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
a4 f?
DATE: 06/05/2018 T, \
GIS ID:70700215 FEE: 0.00
MUNIS APPLICATION# 201800861EXPIRATION DATE: 07/05/20I8
APPLICANTLOCATION
NAME: ATLANTIC EXCAVACION IN'Q ADDRES.-Si '1IN PLACE
ADDRESS: 363 PARUM ROADig 'r �1VLUILDING CO INC
COLCHESTER,CT Q'44"Y STREET
1
TON,CT 06790
PHONE
WORK DESCRIPTION: NEW SE . SOR WOODS
� i�i7$CTi�I`I IOIt'BUIf] TNGO[ ,Q �I' ND
PERMIT�kU
C�I LIGLDtT� �}10083 k �
THE DRAIN LAYER ASSIGNED TO THIS� E N T'IIAS A U�4LII? II� Efi$SUE1BIILSTATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORmd IN THI t�FTAC1 �C t1 I T1 QN � .�,kV RK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDAS;, LSIA RE�CIIIt�EIVIENr7�S� F 1 III ATTACHED CONDITIONS.
# v✓-
1
ISSUED BY DATE INSPECTED INSPECTED BY
6/5/20I8 I I:26 AM
.1"p
pio
fe
WY .Rr✓4N �..:•� kc F��yr ���� P J 5�t�'�S,r4 �
g,
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: CONTRACTOR: a—T) t)'c-
LOCATT®Ns z2J6 10/ -,�
` YPE OF WORK. Yle
DATE INSP NEEDED: DATE INSP., 6:`6
INSPECTED BY;
WORK IN
PROGRESS;
c
Ao
J" Lai—
m"L���d � G:+Ls 1s�¢ia� :�"f✓ `? - fib...- '2y.°� 4). 4 `�fC]es �, .
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ®YES NO'
AS-BUILT;
INPUT: DATE:
S/molloy/forms 2014 Town of South Windsor INPSECTIO U 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
QA
Location of proposed work: .Lot- #
Street No. Street Name
Premises owned by: v ,
Name of Firm: ' '. Phone:
Address of Firma YL23
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 j T
Existing Water Supply: Public Water Well
Proposed Start Date 5;;� 7 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. ,rg�y - P7 . 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.
CDYD No. 2-d-Z� 2-2 PLEASE NOTE-.
IF A SANITARY SEWER LATERAL
IS WITHIN 75 FEET OF A WELL
IT MUST BE AIR TESTED
Signed: '" Print Name: ��
Licensed D- -- yer
Date: a
Standard Forms�Permlts\APPLICATION FOR DRAIN LAYERS PERMIT REVISION 2017.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS G I-57 3 cj
STREET
SUBDIVISION:
NORTH ARROW '105 109e.
I -
T.
tj
4
eTJ
vvi-
Y
- _ _
CONTRACTOR (PRINT) NAME OF CO T RCS SUPERVISOR (PRINT)
ST EET ADDRESS SIGNATURE
tee
TOWN STATE ZIP INSPECTED BY TOWN
_%rj 4 fit-V DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER