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HomeMy WebLinkAboutDrain Layers Permits 247 Deming Street 1800032 TOWN OF SOUTH WINDSOR, CT PERMIT NUMBER DRAIN LAYER PERMIT d DATE: 05/11/2018 r ' GIS ID: 27600247 s FEE: 80.00 MUNIS APPLICATION# 201800662 . '*t,� a t EXPIRATION DATE: 06/10/2018 •y l 51 APPLICANT :... �<< rA LOCATION NAME: WASTEWATER SEIiI(4Sfp1A SSPS ADDRESS 247>DMING STREET ADDRESS: 21 COURTNEY DRI✓ � ' ?WNE F, 0X, ELMAR&BEVERLEY G ELLINGTON,CT 06;02 247 DEMING STREET µ SOUT�I WINDSORf CT 06074 Y � r PHONE moo WORK DESCRIPTION: NEW SWFTbECTr©1�fi THE DRAIN LAYER ASSIGNED TO THI �PEIT HAS IIJ E, SSLIETl �'TILL STATE AND HEREBY AGREES TO ALL THE TERMS AND CONDITIONS SET FOR'IfI�t THE..;ATTACHD`CQI�IDITIQI�u� L ORK SHALL BE IN ACCORDANCE WITH THE TOWN OF SOUTH WINDSOR STANDARDS,AI L OS IA n.E; i Mly1i1T5,A14D i ATTACHED CONDITIONS. ISSUED BY DATE INSPECTED INSPECTED BY 5/11/2018 11:09 AM i e5X ) I t L 5 41 .NI jw j t fy S a Ali •i y ti' ` y5 4 ti t yd i 41 •' ,, ty " TOWN OF SOUTH WINDSOR INSPECTION REPORT PERMIT NO.: � QbO CONTRACTOR:S LOCATION: C -1 ` TYPE OF WORK: Aal DATE INSP NEEDED: DATE INSP: INSPECTED BY: WORK IN PROGRESS: SEPTIC TANK PUMPED,SMASHED, FILLED WITNESSED ❑ YES ❑ NO' AS-BUILT: INPUT: DATE: 5/moiloy/Ports 2ol4 Town of south Windsor INPSECTIQN 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: Lot # Street No. Street Name Premises owned by: 4 �- wo Name of Firm: �al;�;�n.� �/:�s4�wv� Phone: �n� Address of Firm:_"?A O ou t Or 4 C' 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 ( " �0 4 �� r' t✓(- Existing Water Supply: Public Water Well Proposed Start Date e 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 m G014/,t�Z the holder of Drain Layer's License No. o oo -`I z Only holders of P- P-7 r 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 MUST BE AIR TESTED Signed:'Print Name: Li eased Drain Layer Date: Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT REVISION 3/2016.doc