HomeMy WebLinkAboutDrain Layers Permits 643 Deming Street 1.800049 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 07/09/2018 CY .� ux = ' 'v
r GIS ID:27600643
FEE: 80.00
MUNIS APPLICATION# 201801162 EXPIRATION DATE: 08/08/2018
APPLICANT �:.' 4 y s ; zn � �k =4 LOCATION
NAME: EAGLE EARTHWOFRV „ �` 4 ADRE i£43 BEING STREET
41,
ADDRESS: 101 N MOUNTAIN �f; OWI`TEI }1k �1N?iRiNO BUILDERS INC
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CANTON,CT 06019, 3 k £51 Y z'' e� � � `` 4Q`��HAQEL RD 3R
RrINDSOR,CT 06074
PHONE 860-693VO77, }� ;
.5 S
WORK DESCRIPTION: NEW SEVC4�I3TI )Nr
THE DRAIN LAYER ASSIGNED TO THIS'1 ER IT S A A I EI* E SSU I IY TTl STATE.AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORT! �'rIO �q Wr(3RK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STAND s,ATE(351 REQ7IZEMNTB,,A�X*IT `ATTACHED CONDITIONS.
ISSUED BY DATE INSPECTED INSPECTED BY
7/9/2018 11:01 AM
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TOWN OP SOUTH 1NNDSQR INSPECTI®iV R PORT E
PERMIT NO.: CONTRACTOR:
LOCATION: ��v�- �Y1 Slog. '
TYPE,OF WORK: ,"Ie"I'orliff'.
DATE INSP NEEDED:; DATE INSP;
INSPECTED BY:
WORK,IN
PROGRESS: cn4j e. IL 3 F✓i ,
SEPTIC TANK PUMPED,SMASHED, FILLED L WITNESSED ❑YES 0 NO
AS-BUILT:
INPUT: DATE.
114
S/Molloy/forms 2014 Town of South Windsor INPSEMON 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. St'rek Name
i
Premises owned by:/'l�x�q o"LaJ1;rlo
Name of Firm: afa1i-1qed,.,)AkPhone: L9--6 23 z�
Address of Firm: /01
TYPE OF WORK:
Lay House Drain D\ ; 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 6 , py(,
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
r
Permit is to be issued to A014,01 Vn(W'b the holder of Drain
Layer's License No. 27g� [l 0 . 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.201 004t 2� PLEASE NOTE:
IF A SANITARY SEWER LATERAL
IS WITHIN 75 FEET OF A WELL
IT MUST BE AIR TESTED
Signed: �mv. Print Name' •r %c
Licensed Drain Layer
Date: _ f?`
Standard Fcrms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT REVISION 3/2010.dac
TOWN OF SOUTH WINDSOV
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: � - Lo - 18
BUILDING ADDRESS Cq 7?
STREET
SUBDIVISION:
NORTH ARROW
I I I
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CONTRACTOR (PRINT) NA E 0 .0 NTRACT R'S SUPERVISOR (PRINT)
161 Nof-4 ae�
STREET ADDRESS S ATURE
C—c—'2 ..,.....DATE
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TOWN
STATE ZIP INSPECTED BY TOWN
DATE
TELEPHONE NUMBER
WHITE — TOWN PINK — CONTRACTOR YELLOW — CONSULTING ENGINEER / DEVELOPER