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HomeMy WebLinkAboutDrain Layers Permits 18 Farm Hill Road (2) 1800070 TOWN OF SOUTH WINDSOR CT PERMIT NUMBER DRAIN LAYER PERMIT .. S DATE: 09/24/2018 -` 4 GIS ID:31700018 k FEE: 80.00 MUMS APPLICATION# 201801737 a 1 kk rfr ,� ivy, EXPIRATION DATE: I0/24/2018 jr APPLICANT 4 r r� F n3 LOCATION NAME: SSC CONSTRUCTION'1IC w �� `� � DRES ��;8'Ft1Ri HILL ROAD ADDRESS: 1700 SAYBROOK RCA L ND XVIII LIMITED PARTNERSHIP } y 42 C3LD RIDGEBURY ROAD MIDDLETOWN,CTOr4�ry3.7 PHONE J yF z WORK DESCRIPTION: NEW SEXO '�I �C 3 iNEGTI Iy � � g- 1' r ANN THE DRAIN LAYER ASSIGNED TO THISEI�ITttAS A�7 ,jD� SD'ISSUTr�Y STATE AND HEREBY AGREES TO ALL THE TERMS AND CONDITIONS SET FORA IN`TI3E A`TTiAD,sCID23 Ifw I,V (RK SHALL BE IN ACCORDANCE WITH THE TOWN OF SOUTH WINDSOR STAND TIE ATTACHED CONDITIONS. 1 n a -gV V' c 11 S x ISSUED BY DATE INSPECTED INSPECTED BY 9/24/2018 3:34 PM 04 t f s +r "'o. wo 7 �`x Y :clt ry r 3 ��r TOWN OF SQUTH WINDSOR INSPECTION REPORT PERMIT NO.: CONTRACTOR: ,5Pf L� 26Z LOCATION: TYPE OF WQRK: ' DATE INSP NE.EQE'. DATE INSPECTED BY: 411 WORK IN PROGRESS: pvc .5 _ �'�"' �c ioo.�. . l� ve.y.rr.c2 -�-a � f S eH �1 U � s�;,,.,Yc✓v►•C t� rg SEPTIC TANK PUMPED,SMASHED, FILLED WITNESSED ❑YES [] NO AS-BUILT,' . .^ INPUT: � (� DATE:..'_ .. s/molfoy/fomns 2m4 Town of south Windsor•INP5kltN REPORT 14 I j 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: tA:k` a `D Lot # Street No. Street Name Premises owned by: -`�0t k 13 i 05-. `)�YIC- Name of Firm: SSc"(�0y15+r(A-we-\ 0 ,c - Phone: Y6cl 2so• � D� 13 Address of Firm: t'7a 0 Sa`(Lrroc;k QZ 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 6" SD n- Existing Water Supply: Public Water Well Proposed Start Date �r Estimated time fnr completion 2`r r 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. RIM ©2r7rk1-07 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. 2v(B"3�4© ?S� PLEASE NOTE: IF A SANITARY SEWER LATERAL IS WITHIN 75 FEET OF A WELL IT MUST BE.AIR TESTED Signed: Print Name: 5 cc,G •,C- �, Licensed Drain Layer Date: • Z`' . c Standard FormsXPermits\APPLICATION FOR DRAIN LAYERS PERMIT REVISION 3/2018,doc i� TOWN OF SOUTH WINDSOR ( SANITARY SEWER _ _ . LATERAL FIELD. LOCATION DATE OF CONSTRUCTION: P. BUILDING ADDRESS I STREET SUBDIVISION. ��� :; NORTH ARROW t i � f _ 1 T41- _ = t I --1El 97 Z E I I -- SAC (.�=�1,`.i�1�'✓�:�.1° cn 1\L i e-ie,4s CONTRACTOR (PRINT) NAME OF NTRACTOR'S SUPERVISOR (PRINT) STREET ADDRESS ` SIGNATURE /,S ATE �- TOWN STATE ZIP INSPECTED BY .TOWN r SCE 3 i DATE TELEPHONE NUMBER WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER