HomeMy WebLinkAboutDrain Layers Permits 52 Shepard Way 1800051 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 07/17/2018 J
GIS ID: 82600052 t FEE: 80.00
MUNIS APPLICATION# 201801233
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APPLICAN t
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NAME: ATLANTIC EXCAVAtIO,N I�IC K AD�7RE = 2IIEARD WAY
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ADDRESS: 363 PARUM ROAD 113JILDING CO INC
COLCHESTER,CT 041
V 11 ROOK STREET
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IN@TON,CT 06790
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WORK DESCRIPTION: NEW SE I ;G0�1 ,CTION �; Rom ;
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THE DRAIN LAYER ASSIGNED TO THISERI�ITyLTA�S A � CIiNT�SSUIT $YFSTATE.AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORT1 L BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDAft5; 'ATTACHED CONDITIONS.
ISSUED BV DATE INSPECTED SPECTED BY
7/17/2018 10:43 AM
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TOWN.. OF SOUTH W-1 MOR INSPECTION RE. T
PERMIT NO.: ADD CONTRACTOR: vii fx�G >0 R�
LOCATION.--
TYPE OF 1NORK:
DATE INSP NEEDEQ: DATE INSP;
INSPECTED BY;--.
WORK IN -
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SEPTIC TANK PUMPED,SMASHED, FILLED WITNESSED ❑ YES ❑ N0
AS-BUILT:
INPUT: Wes- DATE: '1
S/molloy/forms 2014 Town of Souftt Windsor.ImEmON 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: .5�.+� o�� r� �, Lot #_ e;?
Street No. Street Name
Premises owned by: ZZ kf
Name of Firm: Phone:
Address of Firm:_
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 �' � S PIP ,35-
Existing Water Supply: Public Water '�� Well
Proposed Start Date 7 7 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 c the holder of Drain
Layer's License, No.e:� ?o 53R8'S?y- /�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. 25201T.??0 0 ,9,3S . PLEASE NOTE:
IF A SANITARY SEWER LATERAL
IS WITHIN 75 FEET OF A WELL
IT MUST BE AIR TESTED
Sign f Print Name: �C��� �
Licensed DrLayer
Date:
Standard FormsNPerm[ts\APPLICATION FOR DRAIN LAYERS PERMIT REVISION 3/2018.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: ~ 1-7' 1%
BUILDING ADDRESS Z
STREET
SUBDIVISION:
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CONTRACTOR PRINT) NAME 0 NTRA 0 ' SUPE INT}
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ST ET AQD ESS NA R ,
c< �.��, _ DATE
TOWN STATE ZIP lNe/hid BY TOWN
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TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER