HomeMy WebLinkAboutDrain Layers Permits 340 Buckland Road ... . .. . . . .... _
� 1800067
TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 09/06/2018 yc
GIS ID: 15300340
FEE: 80.00
MUNIS APPLICATION# 201801613 K r EXPIRATION DATE: 10/06/2018
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APPLICANZrfLOCATION
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NAME: HOLDEN CONSTRUCTION LLC ADDRE � . 3�40 BUKI AND ROAD
ADDRESS: P O BOX 357 h fi ' [
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71NNbUSH FAMILY OF SOUTH WINDSOR
�ry�r 12 I✓LM STREET
ELLINGTON, CT 060; _. � � k
PHONE .
413-478; 989 f k x
WORK DESCRIPTION: NEW SEA'° ;ECTT 1r
THE DRAIN LAYER ASSIGNED TO THIS 'ER1ytITAE A41 ,ID? NTSUEIj g�y�THE SATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORTE III TII1;"t�TTACI�I?iT,�`GONDTTIQNSsY' 17 L W RK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDA 1 ,AIvL�OSHA REQUTTKbMEI J'S,ANi TI ATTACHED CONDITIONS.
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ISSUED BY DATE INSPECTED INSPECTED BY
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MW.N DF SDU M WINDSOR INSPECTION REPORT
PERMIT NO.: . C 2 CONTRACTOR:
LOCATION: G z:-,i Xe)0
TYPE OF WORK:_ &eLt.) ��� C100Y-) I-i,
DATE INSP NEEDED: DMEINSP:
INSPECTED BY:
WORK IN
PROGRESS: r,-.
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SEPTIC TANK PUMPED,SMASHED; FILLED WI MESSED ❑YES [I NO-
AS-BUILT:
INPUT: DATE: `� .. �0' 1
S/molloy/fbrrns 2014 Town of South Windwr•IWPSEftN REPbpT 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: 3L[0 v Lot #
Street No. Street Name
Premises owned by: cis o r�vi7 L�?�v,Ds
Name of Firm: Phone 13-4/79- Tlcc(j
Address of Firm:__ 1` o SaK 32 7
TYPE OF WORK:
Lay House Drain ; Repair House Drain ; Sanitary Disconnect
Lay Lateral for building with connection or no connection ��
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Lay Main_
Lay Lateral for Commercial/Industrial Building number of acres
Connection will be made with
Existing Water Supply: Public Water f/ Well
Proposed Start Date Estimated time for completion c6' 5
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 APL-4CaN th older of Drain
Layer's License No. o Only holders of P-1 P-7 r W-9 licenses
will be issued a permit. PERMIT WILL EXPIRE THIRTY(30 YS 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 ConnMT Permit No.
CBYD No. 1 S 3 °P o c PLEASE NOTE:
IF A SANITARY SEWER LATERAL
IS WITHIN 75 FEET OF A WELL
IT MUST BE-AIR TESTED .
Signed: Print Name: y�
Licensed Drain Layer
Date: q16 ZZ8
Standard Forms\PermbXAPPLICATION FOR DRAIN LAYERS PERMIT REVISION 3/2018,doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: t
BUILDING ADDRESS 3 4&
STREET • ;.-XL4A;
SUBDIVISION:
NORTH ARROW
I I T
I _
76
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CONTRACTOR (PRINT) NAME OF CO TRACTOR'S'Sl1PE ISOR (PRINT)
STREET ADDRESS SIGNAT R
TOWN STATE ZIP INSPECTED BY TOWN
eaeoO . 7`3 <41 '2. DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW -- CONSULTING ENGINEER / DEVELOPER