HomeMy WebLinkAboutDrain Layers Permits 16 Schoolhouse Driv (2) 1800084 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 11/06/2018 t„
GIS ID: 81200016s ` FEE: 80.00
MUNIS APPLICATION# 201802202 rr tr F t s�` ;^ EXPIRATION DATE: 12/06/2018
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APPLICANT' s ry u �t k LOCATION
NAME: EAGLE EARTH OW R A,RV l�IJDRE IB SCIOOLHOUSE DRIVE
ADDRESS: 101 N MOUNTAIN RO ,D - OWIIr IvI�N�IARINO BUILDERS INC
rti 40.0 CHAPEL ROAD UNIT 3-F
CANTON, CT 060111
PHONE 860-69%72(127 Y
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WORK DESCRIPTION: NEW SI�W""pu,GO1�NTaCTTON � 1 yOEM��5 x
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THE DRAIN LAYER ASSIGNED TO kl. III HAS A ALTI LTof 1r�ISSU,I;]��BY THE STATE AND HEREBY AGREES TO ALL
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THE TERMS AND CONDITIONS SET FOR11 IN I Et T F 1 I ED`CO ?IT,IONS`° AEI✓ ?ORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDA1tDS,A.L OSHA REQU..IREMEk*iTS,.j#1r:D TIDE ATTACHED CONDITIONS.
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ISSUED BY DATE INSPECTED INSPECTED BY
11/6/2018 12:29 PM
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TOM OF SOUTHMINDSOR#!"ECCO N REPORT
PERMIT No.:-Anoa4. CDNTRACTDR: Z�'a 4
LOCAtOk 16 . 5e •.• l og ssz f
TYPE OF WQRK:
DATE INSP NEEDED:' DATE
INSPkttD-B—l- �
WORK IN
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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 osed work: sc` op
1 hp-a-ePa Lot #
U-44
Street No. Street Name
Premises owned by: ''1��� 7b ,4A
Name of Firm: � '�P '�?r r weig k Phone: go 69,1 10Q
Address of Firm: () /1 �> el-
TYPE OF WORK-
Lay House Drain ✓l; 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
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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 ��� � tul the holder of Drain
Layer's License No. 2 781 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. PLEASE NOTE:
IF A SANITARY SEWER LATERAL
IS WITHIN 75 FEET OF A WELL
IT MUST BE AIR TESTED
Signed Print Name: E
Licensed Drain Layer
Date:
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT REVISION 3/2018.doc
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TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS : 16 13
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STREET . -P.
SUBDIVISION: hodlhovsc
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CONTR OR (PRINT) LL NAMF 0 CO TRA OR'S SUPERVISOR (PRINT)
ST EET ADDRESS SIGNAT
N / STAT ZIP INSPECTED BY TOWN
DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER {