HomeMy WebLinkAboutDrain Layers Permits 201 Pepin Place 1800039 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 06/05/2018 4 i ` 4
GIS ID:70700201
FEE: 80.00
MUNIS APPLICATION# 201800855f r 5 �5�. y4ti
# 1� � EXPIRATION DATE: 07/05/2018
APPLICANT LOCATION
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NAME: ATLANTIC EXCAVAf I T ANC T' ERIN PLACE
ADDRESS: 363 PARUM ROAD ILDING CO INC
COLCHESTER,CT 0164 ^� ` Y 53lp�$ROOK STREET
JQRI.TNiTON CT 06790
PHONE ti AP,
WORK DESCRIPTION: NEW SE� C1�1ETTrI FOR BUT ;] 6tQ,(7 �INDSOR WOODS
201-221
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THE DRAIN LAYER ASSIGNED TO THIS pEWT BIAS A 1ID SICE> E ISST�IJT B, ATATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET F0011 IN fiHE t1�I TA I `COI* IT QI«1S'� A W6RK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDA S;A)�,L OSI I ECRU 2EIu1E1�IT!�r,ANn TJ L ATTACHED CONDITIONS.
ISSUEWBY DATE INSPECTED INSPECTED BY
6/5/2018 10:30 AM
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TOWN OF SOUTH WINDSOR`INSPECTION REPORT
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PERMIT NO.: '6�0YOCONTRACTOR:
LOCATION:
TYPE.OF STORK; Yle c,L2 _ S:P-W-e-t
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DATE INSP NEEDED. DATE INSP;
INSPECTED BY; z
WORK IN
PROGRESS;
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SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑YES E NO
AS-BUILT: 1
INPUT; DATE:
S/molloy/forms 2014 Town of South Windsor.INPSSMON REPORT 14
APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $80.00
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Location of proposed work:.o0d A2,?/ . 'n / ce
Street No. Street Name
Premises owned by: / c�
Name of Firm: fc Phone: �o—�� �/76'
Address of Firm: �% Off- PIS
TYPE OF WORK:
Lay House Drain Z--"�Repair House Drain ;
Lay Lateral for building with connection ; or no connection ;
Lay Main ;
Lay Lateral for Commercial/Industrial Building number of acres
Connection will be made with C33
Existing Water Supply: Public Water � Well
Proposed Start Date �$ 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 the holder of Drain
Layer's License No.(nZo 48g iy ^ ;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. 2CAF 2ao. / PLEASE NOTE:
IF A SANITARY SEWER LATERAL
IS WITHIN 75 FEET OF A WELL
IT MUST BE AIR/TESTED
Signed: Print Name:
Licensed Drain er
Date; Lr B`
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 VA I 6 117 rX
STREET
SUBDIVISION: r
NORTH ARROW 1` 110 �1 -al
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CONTRACTOR (PRINT) NAME OF CO T RCS SUPERVISOR (PRINT)
1675 �
ST EET ADDRESS SIGNATURE
DATE
TOWN
�/ STATE ZIP INSPECTED BY TOWN
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o-, 7 -7- � �� DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER