HomeMy WebLinkAboutDrain Layers Permits 9999 Nevers Road 1800038 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER
DRAIN LAYER PERMIT
DATE: 05/31/2018 z f�
GIS ID: 62409999
�£� w h" h FEE: 80.00
MUNIS APPLICATION# 201800812 A , - u° � `1 EXPIRATION DATE: 06/30/2018
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APPLICANT ' LOCATION
NAME: SIMSCROFT ECHO FAR !IS4` r t s 4 ApDRE$S NL1E ROAD
ADDRESS: P 0 BOX 58141OWNEZ� F SOUTH WINDSOR
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SIMSBURY,CT 060 0 � s1 r �? 5'4 SUbLIVAN AVE
tti� y wx z r trVINDSOR,CT 06074
PHONE 860-651r§023 1 G a
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WORK DESCRIPTION: LAY SE�R,'VIrTi�1 FOR TI L 13R4TIERS�N NEES ROAD
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THE DRAIN LAYER ASSIGNED TO THIS E r r T H S A At DrLI sI� SSU1;Uf' Y I STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FOR THL A� �11 �� IDi 1 IONS ��,V ARK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STAND; {tl bSI�I#ItE TjIREIVIEI 1,,I�N]Q T ATTACHED CONDITIONS.
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ISSUED Y DATE INSPECTED INSPECTED BY
5/31/2018 1:55 PM
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
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PERMIT NO.: 000,39 CONTRACTOR:
LOCATION: 1�q99 's 9,00-cp-
7YPE OF WORK:
DATE INSP NEEDED. DATE INSP: r o
INSPECTED BY: y�
WORK IN
PROGRESS:...
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SEPTIC TANK PUMPED, MASHED, FILLED WITNESSED ❑YES ❑ NO
AS-BUILT:
INPUT: DATE:
S/Molloy/farms 2014 Town of South Windsor INPSECMN 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: �,�� ��,r_`� Lot #
Street No. Street Name
Premises owned by:
Name of Firm: i ,��� �_,� - �,� . Phone:ao3 UAL-µ ,ou
Address of Firm: ti Z , �� � �, , ��� Li � •��
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 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 the holder of Drain
Layer's License Na. Only holders of P-1,,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. j(9t q_X(908 YC,(e PLEASE NOTE:
IF A SANITARY SEWER LATERAL
IS WITHIN 75 FEET OF A WELL
+' IT MUST BE AIR TESTED
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Signed: .:�: �� ��� Print Name C,
Licensed Drain Layer
Date:
Standard Forms\Permlts\APPLICATION FOR DRAIN LAYERS PERMIT REVISION 3/2018.doc