HomeMy WebLinkAboutDrain Layers Permits 16 Fairview Drive (2) 1800053 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER
DRAIN LAYER PERMIT
DATE: 07/24/2018 , 0
GIS ID: 31500016 c' i usey
MUNIS APPLICATION# 201801287 six Of qi17 t FEE: 80.00
� s 't ark EXPIRATION DATE: 0$/23/2018
APPLICANT' t K
NAME: WASTEWATER BERM S/IBA SIiPS_k AIDRE ,' j¢ AVIlOW— D~
ADDRESS: 21 COURTNEY DRIVI!" t �`
xDTEl L¢ PQU MARK J&MARIA A
y
ELLINGTON,CT 0672� s k r 3s 4 4*41 'AtRIEW DRIVE
PHONE 3 _
WORK DESCRIPTION: NEW SEWRf-aiC. ; pacTI
q S 4
Eiv
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THE DRAIN LAYER ASSIGNED TO THIS€?ER�IISS A ',e; �pJss` j , SSUT32IYTIF,� TATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORTi IN T#JEyTTA
THE TOWN OF SOUTH WINDSOR STAND k � ipI1Qxa AIs WORK SHALL BE IN ACCORDANCE WITH
AIE bsIA REQUIREIVTENTS;A+Ifl "ATTACHED CONDITIONS.
ISSUED BY DATE SPECTED INSPECTED BY
7/242018 4:12 PM
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TOWN OF SOUTH WINDSOR INSPEC'10N REPORT
PERMIT NO.: DOO CONTRACTOR: l�c�k loQ
LOCATION:.-..._/to Fa e-., Dml 16
TYPE OF WORK: cj2 n r),Pr-34&k)
DATE INSP NEEDED: DATE INSP: 7b I'
INSPECTED BY:
WORK IN
PROGRESS:
ecui
SEPTIC TANK PUMPED,SMASHED, FILLED � WITNESSED ES ❑ NO
INPUT: DATE: '
5/Molloy/forms 2014 Town of south Wtnftor 111PSWMIO REPORT 14
APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $80.00
Location of proposed work: & /Z V e f'4d Lot #
Street No. Street Name
Premises owned by: S77 PH C fi-AtG /=crab
Name of Firm: <5K1'A5' Phone: 5Cv- 2 7 S z 312--
Address of Firm: 2 0- 7-rN e y 2) iz CLL 1'4 & %V nl C7
TYPE OF WORK:
Lay House Drain >(-; Repair House Drain ; Sanitary Disconnect
Lay Lateral for building with connection ; or no connection ;
Lay Main
Lay Lateral for Commercial/Industrial Building number of acres
Connection will be made with C PVC- s'b/Z- 3 S"
Existing Water Supply: Public Water Well
Proposed Start Date 7� �_f Estimated time for completion '7-z s-,
ALL WORK TO BE IN ACCORDANCE WITH TOWN OF SOUTH WINDSOR STANDARDS,
ALL OSHA REQUIREMENTS AND CONDITIONS ATTACHED TO THE PERMIT
Permit is to be issued to -rdT"k the holder of Drain
Layer's License No. o z a 7-72- a . Only holders of P-14E�Dr W-9 licenses
will be issued a permit. PERMIT WILL EXPIRE THIRTY(30) DAYS AFTER
DATE OF ISSUANCE. The undersigned Drain Layer hereby agrees to all the terms
and conditions set forth in the permit and attached thereto. Applicant has received
Town Street Excavation Permit No. and/or ConnDOT Permit No.
CBYD No. �2-olg '3-00 9 6 PLEASE NOTE:
IF A SANITARY SEWER LATERAL
IS WITHIN 75 FEET OF A WELL
IT MUST BE AIR TESTED
Signed: Print Name:
icensed Drain Layer
Date: 7-Z4 - /$
Standard Form s\Permits\APPLICAlION FOR DRAIN LAYERS PERMFr REVISION 3/2018.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: '
BUILDING ADDRESS
STREET
SUBDIVISION:
NORTH ARROW
-- _
12L E 3
�.iL�� Nw1P�.�4-� .�Ce.��yi' _�r°r+,r"c� i-`��''J !J�; a', �•t `//`f.
CONTRACTOR (PRINT) NAME OF NTRACTOR'S SUPERVISOR (PRINT)
STREET ADDRESS SIGNATURE
DATE
TOWN STATE- ZIP INSPECTED BY TOWN
DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER