HomeMy WebLinkAboutDrain Layers Permits 744 Sullivan Avenue (2) I800057 TOWN OF SOUTH WINDSOR, CT
ITN UMBER DRAIN LAYER PERMIT
DATE: 08/06/2018
GIS ID: 87300744 FEE: 80.00
MUNIS APPLICATION# 201801408 EXPIRATION DATE: 09/05/2018
APPLICANT LOCATION
NAME: ENVIRONMENTAL SERVICES INC ADDRESS: 744-746 SULLIVAN AVENUE
ADDRESS: 90 BROOKFIELD STREET OWNER: MITCHELL JOHN J SR&DELLA T
744 SULLIVAN AVENUE
SOUTH WINDSOR,CT 06074
PHONE 860-528-9500
WORK DESCRIPTION: SEWER DISCONNECT HOUSE BEING DEMOLISHED
744-746 SULLIVAN AVENUE
THE DRAIN LAYER ASSIGNED TO THIS PERMIT HAS A VALID LICENSE ISSUED BY THE STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORTH IN THE ATTACHED`CONDITIONS'. ALL WORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDARDS,ALL OSHA REQUIREMENTS,AND THE ATTACHED CONDITIONS.
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ISSUED BY DATE INSPECTED INSPECTED BY
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TOWN OF SOUTH WINDSOR INSPEC71ON REPORT
PERMIT NO.: I 90005 7 CONTRACTOR:Ell Ul L n rnu•Ta Si r
LOCATION: 2Ny.• 7Y/ Su Ill 1/AA A Ue n u e
TYPEOF WORK: Ses►ic�_c �,�I s�1'�Qr_T Na aS� �ir��, c�,r�►YIi1�: S�cQ
DATE INSP NEEDED: DATE INSP: 3 lid
INSPECTED BY: Q i_�
WORK IN
PROGRESS: (':,
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑YES ❑ NO
AS-BUILT: •
INPUT: \N" - DATE: •
5/moiloy/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' 4 Jq'6 S L j(Al�ti A` f- Lot #
p p
S ee o. 11 Street Name
Premises owned by:
Name of Firm: CNvJr--00M L-,v4, l m6 Phone: a U 5df 9S00
Address of Firm: 90
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
Existing Water Supply: Public Water Well
Proposed Start Date R k i F Estimated time for completion i
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 CND,20,��w�� s�tiv.�t h the h Ider of Drain
Layer's License No. o-' G9- Only holders of P-1/,F-7 r W-9 licenses
will be issued a permit. PERMIT WILL EXPIRE THIRTY (30) AYS 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. 2Q1 S 9,S 01 Q 6 / PLEASE NOTE:
IF A SANITARY SEWER LATERAL
IS WITHIN 75 FEET OF A WELL
IT MUST BE AIR TESTED
Signed: Print Name: ICI -
IlLiceIrrain Layer `
Date:
Standard Forms Permits\APPLICATION FOR DRAIN LAYERS PERMIT REVISION 3/2018.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: 0 6
BUILDING ADDRESS
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SUBDIVISION:
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CONTRACTOR (PRINT) NAME 0 CONT TOR'S SUPERVISOR (PRIN )
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STREET ADDRESS SIGNA U E
15 IM,Ao Q SG 2 � � 13 DATE
TOWN STATE ZIP INSPECTED BY TOWN
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TELEPHONE NUMBER
WHITE — TOWN PINK — CONTRACTOR YELLOW — CONSULTING ENGINEER / DEVELOPER
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