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HomeMy WebLinkAboutDrain Layers Permits 340 Buckland Road (2) 1800064 TOWN OF SOUTH WINDSOR, CT PERMIT NUMBER DRAIN LAYER PERMIT S ~k DATE: 08/28/2018 r t ; GIS ID: 15300340 0, FEE: 80.00 MUNIS APPLICATION# 201801547 jf � n 5'. 5 � 25 EXPIRATION DATE: 09/27/2018 a #� ri N Z tir Fi ; APPLICANT }C C. pi 4 aL LOCATION NAME: HOLDEN CONSTRU( IqNb KLAND ROAD B ADDRESS: P O BOX 357 iv { s r y OE 7`TI�N USH FAMILY OF SOUTH WINDSOR L14 STREET ELLINGTON,CT 00bg79 �° , h ; 4�� x PHONE 413-478bV8 WORK DESCRIPTION: LAY SEtw,Iry' NI' THE DRAIN LAYER ASSIGNED TO THIS, E 1 HAS A AVID T{I�1 T U I'=1 I' kIF STATE AND HEREBY AGREES TO ALL THE TERMS AND CONDITIONS SET FOR 11H T IE'fi TTTtFIIs) ' iQTA;PtRK SHALL BE IN ACCORDANCE WITH THE TOWN OF SOUTH WINDSOR STANDAk"RS,AFL bSFIA RE L#k 1t�I 1�(FS" p 1I�TIC ATTACHED CONDITIONS. ar �� ISSUED BY DATE INSPECTED INSPECTED BY 8/28/2018 12:22 PM 01 ,�, i Yr> .�cr a. �sy i ''r 5e x - yy yea« 'd "tyi x3 y .nr . ,� .... sly F 5 %i}, . ily Axle, i y Lyyy "owl r ior LA � WW 0 S( # ) TAM O. SOUTHf.WINDSORINSPECOOM REPORT PERMIT NO.: . / '. p CONTRACTOR: & � �. LOCATION: _ � �ti.. Ii� Y ,. _ JZ TYPE OF WORK: ., DATE INSP NEEDED: DATE INSP:_ /�S`�� INSPECTED BY: R WORK.IN PROGRESS; SEPTIC TANK PUMPED,SMASHED, FYLLED w IVESSED ❑YES N® AS-BUILT: INPUT.-__:_ DATE: S/moliuyfforms 2014 Town of South Windsor MPS&TbN 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 Location of proposed work: S 43 �30 Lot # Street No. Street Name Premises owned by: o(js a S©v OIL DSc���LLG ::�rH-v,t- 0cvSH r-" 1(*-V-- o�-- --,f Name of Firm: -'--,Ou24_ 01 ScW � Phone: ���� ' 78 9�� Address of Firm: Q 4�-b R-L TYPE OF WORK: Lay House Drain ; Repair House Drain ; Sanitary Disconnect Lay Lateral for building with connection ; or no connection ; Lay Main C Lay Lateral for Commercial/Industrial Building number of acres Connection will be made with Existing rater Supply: Public Water_ Well Proposed Start Date 8 2y 19 Estimated time for completion W 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 N the holder of Drain Layer's License No 'L M Q o a_2a i 55b(? Only holders of P-1, P-7 or W-9 licenses will be issued a permit. PERMIT WILL EXPIRE THIRTY(36) 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. zt�CBYD No. 1&-,5`4 c I o b n PLEASE NOTE: IF A SANITARY SEWER LATERAL IS WITHIN 75 FEET OF A WELL IT MUST BE.AIR TESTED . Signed: , Print Name:—�)4,p,� irt, -�aC D Licensed Drain Layer Date: ? 21 11 Standard Forms\Permits�APPLICATION FOR DRAIN LAYERS PERMIT REVISION 3/2018.doc TOWN OF SOUTH WINDSOR SANITARY SEWER LATERAL FIELD LOCATION DATE OF CONSTRUCTION: BUILDING ADDRESS : �1 STREET SUBDIVISION: a,._jz/a:k commm . -- - NORTH ARROW 4 i i 1 f � 9 + ' E E � �..� V. i3 ' 11 It II i I rl tA eA AA � ax CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUP VISOR (PRINT) 0-7 mac—- 1 STREET ADDRESS SIGNAT . 7 . 1 j GATE TOWN{ STATE ZIP INSPECTED BY TOWN 4Z 7 DATE TELEPHONE NUMBER WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER