HomeMy WebLinkAboutDrain Layers Permits 45 Tumble Brook Dri 1800071
PERMIT NUMBER TOWN OF SOUTH W I N D S O R, CT
DRAIN LAYER PERMIT
DATE: 10/I2/2018daGIS ID:90600045 �
MUNIS APPLICATION# 201802005y ry .�4xr FEE: 80.00
2711 h� F EXPIRATION DATE:
APPLICANT r fi� i ? ' y� x 11/11/2018
NAME: �r � x {* ,
JAMES THROWE DBA � 'yFd F� ' � "�. 3 .00�IQN
ADDRESS: I330 MAIN STREET �� _ � L BROOK DRIVE
` e
" fimt aFRANK A JR
SOUTH WINDSOR, CT( 074` t � � ''` }` hx s:° TEBROOK DRI
PHONE tY f
860-289-009v�
WORK DESCRIPTION: NEWSEWE' �x � ,' �> Rw
THE DRAIN LAYER ASSIGNED TO THIS PEAd
THE TERMS AND CONDITIONS SET FORTH-1z AD y , 1`T� SAE AND HEREBY AGREES TO ALL
THE TOWN OF SOUTH WINDSOR STANDARI O„ QUHE
t' NIS AAJ;,
s QNS ALIW { HALL BE IN ACCORDANCE WITH
�hgg. �,M D� �i Tr,ACHED CONDITIONS.
ISSUED BY
DATE
10/12/2018 9:27 AM Il `~"D INSPECTED BY
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TOWN OF SOUTH-. INOSOR'INSPECWN REPORT
PERMIT NO.. . {;ONTRACTOR:��v-r\,e,_5, 'yr�c y
LOCATION; MA) e��r c�n��It .
TYPE OF WORK: 0 C.)y'
DATE INSP NEEP8D, DATl INSP: 1 L�
INSPECTED BY.'--Lb
WORKIN
PROGRESS: ae A., A",
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SEPTIC TANK PUMPED,'SMASHED, FILLED Wfl'fyESSED ❑YES 2 NO' .
INPUT: DATE:�...1Q
SIMORoy/forms 2014 Tom of South Windsor INPSWMN REPbRT14
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: Lot #
Street No. Street Name
Premises owned by: LIZ.
Name of Firm °n�5 ,r, .r- �j, „� T� ,,t,, t,-41`Phone:_T(.r)29 j oo rSy
Address of Firm: /3 ?n nac -� -G
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 {S 0 fC' 3 57
Existing Water Supply: Public Water Well
Proposed Start Date 7 `-1 Estimated time for completion J C)C r
ALL WORK TO BE IN ACCORDANCE WITH TOWN OF SOUTH WINDSOR STANDARDS,
ALL OSHA REQUIREMENTS AND CONDITIONS ATTACH® TO THE PERMIT
Permit is to-be.Issued to Ja+� the holder of Drain
Layer's License No. _ 65�6 3� _ _. 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.
i
CBYD No. a)/&�I/0 Vq l S_ PLEASE NOTE:
IF A SANITARY SEWER LATERAL
IS WITHIN 75 FEET OF A WELL ,
IT MUST BE.AIR TESTED .
Signed: Print Name:
Licensed Drain Layer
Date: c t j S,
Standard Forms�Permits�APPLICATION FOR DRAIN LAYERS PERMIT REVISION 3/2016.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS
7 t
STREET .__
SUBDIVISION:
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NORTH ARROW
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CONTRACTOR (PRINT) NAME OF CONTRAC OR'S IJPERVISOR (PRINT)
STREET ADDRESS �" �^ SI TURE
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TOWN STATE ZIP INSPECTED BY TOWN
• > ��r--C DATE
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TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER