HomeMy WebLinkAboutDrain Layers Permits 25 Stone Crossing (2) 1800082 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
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DATE: 1I/05/2018
GIS ID: 86050025 n FEE: 80.00
MUNIS APPLICATION# 201802193 f � ' 4� ' `� % EXPIRATION DATE: 12/05/2018
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APPLICAiNT' �` " `, ? �5,
LOCATION
NAME: WASTEWATER SERr#I,C,,ES/D$A SKIPS; AI?DRI#S5 STONE CROSSING
ADDRESS: 21 COURTNEY DRIES . °F O�NNER }XItQ DAYAN&
a F f5 STOKE CROSSING
ELLINGTON,CT 0662,910 ;s
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PHONE
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WORK DESCRIPTION: SANITAawYy�IE'} '
THE DRAIN LAYER ASSIGNED TO THIS PE,9U ITHAS�J�A1:.ID LIC` N$E ISSUEbhHY TH>� STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORTTI IN .HE ATTA�CI ]�lCf)l+ }1)I03�TS'-tC L WORK SHALL BE IN ACCORDANCE WITH
THE TOWN'OF SOUTH WINDSOR STANDA.pS;' L OSHA REQ:u MENTS,AIa1D TIDE ATTACHED CONDITIONS.
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PERMIT NO.; CONTRACTOR; I ,�a7c� a3• 1 • S
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APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TQWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $80.00
Location of proposed work: Z 5 I^'s S,A Lot #
Street No. Street Name
Premises owned by: z out 14 0/1
Name of Firm: 5 25 �v Pj Phone: �6o V S—z T3 Z
Address of Firm: 2 ( ��� frP � f Al oc,0 z 9
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 Sc t 60 vc
Existing Water Supply: Public Water h Well
Proposed Start Date 1 r r 9 Estimated time for completion 47
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 5�, tJ-s A-- the holder of Drain -
Layer's License No. Only holders of P-1, R-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. 2r-" 6 `f y o z z s I PLEASE NOTE:
IF A SAIV TARY SEWER LATERAL
IS WITHIN 75 FEET OF A WELL
IT MUST BE-AIR TESTED .
Signed: � � �,' l Print Name: /V %k�c s P^k_--
Licensed Drain Layer
Date: r
Standard Forms\Permlts\APPLICA71ON FOR DRAIN LAYERS PERMIT REVISION 3/2018,doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: > z2z/-t3
BUILDING ADDRESS
STREET : 5-Av Cry
SUBDIVISION:
NORTH ARROW
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CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPERVISOR (PRINT)
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STREET ADDRESS SIGNATURE
G' /1eJ�DATE
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TOWN STATE ZIP INSPECTED BY TOWN
DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER