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HomeMy WebLinkAboutDrain Layers Permits 133 Cliffwood Drive (3) 1800055 TOWN OF SOUTH WINDSOR, CT PERMIT NUMBER DRAIN LAYER PERMIT DATE: 07/31/2018 GIS ID:21004133 rat; t MUNIS APPLICATION# 201801358 FEE: 80.00 00/8/�0/LOl w ems' �w EXPIRATION DATE: 18 lh APPLICAN �y �' LOCATION NAME: C&C EXCAVATION ; Ef y q G }ADDRESS „ 3LFWOOD DRIVE ADDRESS: 311 WHITE STREET ; CITIIOSEPH D Jt j' 11 aI{33 CLIFWOOD DR BRISTOL,CT 060101, �k o 4 PHONE % "~ 1 � .s�( �l a�� irk. ../ r~ t2 t 7 r.�s�F �a^ �`4 ,,3 s t i `'t£ ,j `� WORK DESCRIPTION: SEWER "NIVEI `AFT' RFIRE�DL �C �AI+ HOUSE i r THE DRAIN LAYER ASSIGNED TO THIS 'EI3 HkS A�?ALD IJC I� $SUEI1$y TSTATE AND HEREBY AGREES TO ALL THE TERMS AND CONDITIONS SET FORTII�IT��H' ` IA �D ( DIT:����'' SHALL BE IN ACCORDANCE WITH THE TOWN OF SOUTH WINDSOR STAND^4 S;AI I,OSHA RL� IR�itVIEI�7 A Fb T ATTACHED CONDITIONS. t ;'s Y �y ISSUED BY DATE INSPECTED INSPECTED BY '7/31/2018 12:17 PM Y F .rr 2 t v't 1 vm w hry� I 4 Ar AVEt •� A� hhC 4 Rod iF �. "All 1 � �S Af OR tf% T—, k . Alf ' o id rt �5 � Sir y �. 1 5 4 i TDwN OF SOUTH INDSOR INSPEC ON REPORT PERMIT NO.: Cxi©ISS CONTRACTOR: LOCATION: [3 C 1 i 144V-)49DcQ " TYPE OF WORK: -Pu��t f'�°l e)n nPr;' : aILL4i r� �2StV'�/� f)✓ i�a � DATE INSP NEEDED: DATE INSP: ,5 i b INSPECTED BY: WORK IN PROGRESS.-, L-v o �/t j S"l 1 ice. i'�i�J.'i+.f. r;vY! 64,4k V/-0vS- SEPTIC TANK PUMPED,SMASHED, FILLED � WITNESSED ❑YES El NO AS-BUILT. f INPUT; k DATE: 0 . 5/moifoy/fomms 2al4 Town of South Windsor INPSkWN 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 l Location of proposed work: IJ3 06d Lot # Street No. Street Name Premises owned by: Name of Firm: C> . Ile ' Phone: Address of Firm: �e 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 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 the holder of Drain Layer's License No. 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. 9-, ;-n v I c,,5 PLEASE NOTE: IF A SANITARY SEWER LATERAL IS WITHIN 75 FEET OF A WELL IT MUST BE AIR TESTED Signe Print Name: Licensed Drain Ayer Date: c L Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT REVISION 3/2018.doc TOWN OF SOUTH WINDSOR SANITARY SEINER LATERAL FIELD LOCATION DATE OF CONSTRUCTION: 1q1jj eS BUILDING ADDRESS ; .t STREET SUBDIVISION: NORTH ARROW .� _ wl- g t -t- �. 1,7 CONTRACTOR (PRINT) NAME OF C .TRACTOR'S SUPERVISOR (PRINT) STRE ADDRESS SIGNATURE ATE TOWN / STATE ZIP INSPECTED BY TOWN DATE TELEPHONE NUMBER WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER