HomeMy WebLinkAboutDrain Layers Permits 45 Tumble Brook Dri (2) 1800071
TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER
DRAIN LAYER PERMIT
DATE: 10/12/20184 � h :, {✓ u
GIS ID: 90600045
yes, 80.00
MUMS APPLICATION# 201802005 �^ PEE:
�� $� ur P EXPIRATION DATE:
11/11/2018
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APPLICANT � 46 x "
NAME: JAMES THROWE DBA "DCATION
.ADDRESS: 1330 MAIN STREET � � AN
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SOUTH WINDSOR,CT(6 s, h=;074 s Y �' �� BROOK DRI
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PHONE 860-289-009 �s
WORK DESCRIPTION: NEW SEW010, .:�� r' k .
THE DRAIN LAYER ASSIGNED TO THIS PE
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, . $ B T1E ACE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORTH�� WTACHI D h' � ]Nuxf AT Y sv a SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR S-IANDARD` ' p R1;QCII � NTS,ANprT
1�1ACHED CONDITIONS.
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ISSUED BY
DATE INSPECTED BY
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TOWIII OF SOUTH WINDSOR INSREcOOM REPORT
PERMIT NO.: 124O )--2L CONTRACTOR: "
LOCATION: �I _, Ln ld 6L 00
TYPE OF WORK: OVn
DATE INSP NMEPo DATEINSP: i0ZL,7y
INSPECTED BY:
WORK IN
PROGRESS: A.- r� � s rz ��•
SEPTIC TANK PUMPED,SMASHED, FILLED WITNESSED ❑-YES a N0-
AS-BUILT,
INPUT: DATE: ' V
S/mdoyffib ms 2014 Town of South Windsor INS WON 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 Lofi #
Street No. Street Name
Premises owned by:
Name of Firm: U-. (C Phone:.`y)2g oo rSr
Address of Firm: I
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 �5� 3 5
Existing Water Supply: Public Water X Well
Proposed Start Date 7 0`�T Estimated time for completion 0 C 71
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 . Jv rn w-4— the holder of Drain
Layer's License No. j 5-6 Only holders of P•I, 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.
CBYD No. a)!9�1�� Y�11S � PLEASE NOTE:
IF A SANITARY SEWER LATERAL
IS WITHIN 75 FEET OF A WELL
IT MUST BE-AIR TESTED .
Signed: Print Name: s
Licensed Drain Layer
Date:
Standard Fnrms\PermbL APPLICATION FOR DRAIN LAYERS PERMIT REVISION 3/2018.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS .. _
STREET :
SUBDIVISION:
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CONTRACTOR (PRINT) NAME OF CONTRAC OR',S-`SUPERVISOR (PRINT)
STREET ADDRESS �, SI TURE
L
ATE
TOWN STATE ZIP INSPECTED BY TOWN
DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER