HomeMy WebLinkAboutDrain Layers Permits 209 Pepin Place 1800041 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 06/05/2018
GIS ID:70700209 y
FEE: 0.00
MUNIS APPLICATION# 201800857
n EXPIRATION DATE: 07/05/2018
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APPLICANT }` �� LOCATION
NAME: T&M BUILDING.CQ#,SIC*F �y AI?DRES0�}PE11N PLACE
ADDRESS: 110 BROOK STREEZsTwi BFILDING CO INC
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TORRINGTON,CT
rY 3 110BRQIJK STREET
�5 �°� < `� ��` x >�� . s}-•, `Y �w<mTQI��N�TON,CT 06790
PHONE 860-883�591 xk 4 �4
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WORK DESCRIPTION: NEW S R WOODS
PERMITCOLLII�
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THE DRAIN LAYER ASSIGNED TO THTSi ERIT�IItS UfDI � �SSLTEI $ u�IISTATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FOR INTH TTAC=`%,NI3II�, SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDA3;AI3L bSHA IE�QII�REVIE�ITS,rAI TIDE ATTACHED CONDITIONS.
ISSUED ITV DATE INSPECTED INSPECTED BY
6/5n018 I0:46 AM
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TOWN OF SOUTH WINDSOR INSPEC170N REPORT
PERMIT NO.., CONTRACTOR:
LOCATION:. n A16 n oAne
TYPE OF WORK 12
DATE INSP NEEDED: DATE INSPo
INSPECTED BY: ,
WORK'IN '
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SEPTIC TANK PUMPEDI SMASHED, FILLED ►ffNESSED ® YES 0 NO
AS—BUILTa .
INPUTos�h� DATE:
S/moiloy/€orms 2014 Town of South Windsor INPSECFION 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:_ Tit
Street No. Street Name
Premises owned by-
Name of Firm; ' Phone: �
Address of Firm: Z � _
TYPE OF WORK,
Lay House Drain ��';Repair House Drain r
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 Well
Proposed Start ®ate Estimated time for cornpletion �
ALL WORK TO BE IN ACCORDANCE WITH TOWN OF SOUTH WINDSOR STANDARDS,
ALL OSHA REQUIREMENTS AND CONDITIONS ATTACHED TO THE PERMIT
.�Perrrtit is to be issued to the holder of Drain- -
Layer's License No. .`ev Z — P7 . Only holders of Pm1, Pm7 or Wm9.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. Z PLEASE MbTE-
IF A SARIITARY SEWER LATERAL
15 WITHIN 75 FEET OF A WELL
IT MUSS BE AIIR TESTED
Signed: '��� � �'` Print Name:
Licensed Drain r
Date: �w
Standard Forms\Permits\APPLICAT ION FOR DRAIN LAYERS PERMIT REVISION 2017.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: ��
BUILDING ADDRESS : I-57 j in &b
STREET : � a� �
SUBDIVISION:
NORTH ARROW llo5 ®
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CONTRACTOR (PRINT) NAME OF CO R'S SUPERVISOR (PRINT)
10 yCaTA V� c,
ST EET ADDRESS SIGNATURE
ATE
TOWWN'r STATE ZIP INSPECTED BY TOWN
DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER