HomeMy WebLinkAboutDrain Layers Permits 74 Miller Road 1800069 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 09/19/2018
GIS ID: 59700074 z Zr FEE: 80.00
MUNIS APPLICATION# 201801722 EXPIRATION DATE: 10/19/2018
APPLICANT n �;,h
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NAME: JAMES THROWE DB ApDRE3S 74 MILER ROAD
ADDRESS: 1330 MAIN STREET;'� &�ir lbIIGNEULT STEVEN P&DEBORAH L
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SOUTH WINDSOR,f�TJ16(). 4q
PHONE 860-28910695}
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WORK DESCRIPTION: NEW SE�NEICI�GTif Zi
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THE DRAIN LAYER ASSIGNED TO THIS E �TnH S VAMD LT E�NB�I�ISSUEI S YsI ITti STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORI�ZI I� I �e4J,ACjam
C , j`�T"�ALI W_ RK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDAI�ORi\IEQM1✓2�1S;�NF1 THE ATTACHED CONDITIONS.
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ISSUED BY DATE INSPECTED INSPECTED BY
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TOWN OF SOUTH WINDSQR'INSPECTION REPORT
PERMIT NO.:.�f/�Zb� CONTRACTOR:.
LOCATION: Qa�
TYPE OF WORK:
DATE INSP NEEDED: i DATEINSP:
INSPECTED BY: tk
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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: Mt Lot #
Street No. ff Street Name
Premises owned by:
Name of Firm:��r)5` �CN L `
_�� ,Cg C Phone: Z
Address of Firm:-/�3CjiMn054
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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 cad 4' ) '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 wA j rl) the holder of Drain
Layer's License No. F( 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. PLEASE NOTE:
IF A SANITARY SEWER LATERAL
IS WITHIN 75 FEET OF A WELL
IT MUST BE-AIR TESTED .
Signed: Print Name: �, �` i
Licensed Drain Layer
Date:
Standard Forms\Permb\APPLICATION FOR DRAIN LAYERS PERMrr REVISION 3/2018.dac
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS 7
STREET : Tj L U . #AD
SUBDIVISION:
NORTH ARROW
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CONTRACTOR (PRINT) NAME O CONTRACTOR'S PERVISOR (PRINT)
STREET ADDRESS SIG RE
At 2 f e v � DATE
TOWN STATE ZIP INSPECTED BY TOWN
��- dv5- DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER