HomeMy WebLinkAboutDrain Layers Permits 122 Kent Lane 1800086 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 11/07/2018 =;
GIS ID: 50I00122 u s FEE: 80.00
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MUNIS APPLICATION# 201802206 EXPIRATION DATE: 12/07/2018
APPLICANT "w' x LOCATION
NAME: CMC ENTERPRISES�L'I. AUDRE SI �22 KH, T LANE
ADDRESS: 48 EAST DUDLEY PS T IiQf4D Q 1TE$ IiAWLII KRISTEN X
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I1,2 KEIT LANE
BLOOMFIELD,CT 06002 `
PHONE s n 41 4
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WORK DESCRIPTION: SANITA*Y*I72EAcZ'
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THE BRAIN LAYER ASSIGNED TO THIS ER TIT HAS A V7AX III I�ISE{ISS IEI VJW STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET F bL yw'ORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDARDS,�1T L OSkIA 1UIREMETS, SHE ATTACHED CONDITIONS.
ISSUE BY DATE INSPECTED INSPECTED BY
11/7/2018 10:31 AM
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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 work: - Lot #
Street No. Street Name
Premises owned by:
Name of Firm: Phone; r(/ oo
Address of Firm: ` —
TYPE OF WORK: P1 Cc-) m '
Lay House Drain ; Repair House Drain ;
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 l stimated time for completion CD 1�
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 c ` L : -k��(:�O the holder of Drain
Layer's License No. VL .253j Only holders of P-11 P-7 or W-S 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. c 5-'73-. PLEASE NOTE:
IF A SANITARY SEWER LATERAL
IS WITHIN 75 FEET OF A WELL
IT MUST BE AIR TESTED
Signed, Print Name: �
Licensed ain Layer `�j
Date: -- Cnn 1 175
Standard Forms\Permits\APPL.ICATION FOR DRAIN LAYERS PERMIT REVISION 2017.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: J1 �7
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BUILDING ADDRESS
STREET
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CONTRACTOR (PRINT) NAME Of CONTRACTOR SUPERB SOR (PRINT)
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TON STATE ZIP INSPECTED BY TOWN
F- J DATE
TELEPHONE NUMBER
WHITE — TOWN PINK — CONTRACTOR YELLOW — CONSULTING ENGINEER / DEVELOPER