HomeMy WebLinkAboutDrain Layers Permits 57 Schoolhouse Driv 1800088 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 11/14/2018
GIS ID: 81200057 •n FEE: 80.00
MUMS APPLICATION# 201802246INT4�y h EXPIRATION DATE: 12/14/2018
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APPLICANT` S LOCATION
NAME: EAGLE EARTHWO OLHOUSE DRIVE
ADDRESS: 101 N MOUNTAIN RIF AD = OWNIxR t' AN1S1RIN0 BUILDERS INC
i' 400CHAPEL ROAD UNIT 3-F
CANTON,CT 06019 ,�— if r
PHONE 860-693�2027 ^ th4-1
WORK DESCRIPTION: NEW SIt C0 li♦CTIOhI s { 5
THE DRAIN LAYER ASSIGNED TO THIS�FE8WIT HAS A vAL I�I;IG` RISE SU1; $Y Y I STATE AND HEREBY AGREES.TO ALL
THE TERMS AND CONDITIONS SET FORf, THE#TTA1~ID` NI�ITQNS' AIr V �RK SHALL,BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDARDS;2 L OSHA REQFTIMENTS,A7*I)TI-ATTACHED CONDITIONS.
ISSUED B DATE INSPECTED INSPECTED BY
11/I4/2018 10:21 AM
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TOWN OF SOUTH WIN loisiolEclion REPORT
PERMIT NO. CONTRACTOR: Z a 4 �-
LOCATION;, v
TYPE OF WORK, •
DATE INSP NEEDED° DATE INSP. <
INSPECTED-BY:
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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: &ujc Lot #
Street No. Street Name
Premises owned by: A)�14 ;`�3 gae I(
Name of Firm: � Phone: ��
Address of Firm: r - PI— C_ e-P A L
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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 '`i,
A/C-
Existing Water Supply: Public Water X 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 &id<161Loa ' the h I o der of Drain
Layer's License No. q . 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.
CBYD No. PLEASE NOTE:
IF A SANITARY SEWER LATERAL
IS WITHIN 75 FEET OF A WELL
IT MUST BE AIR TESTED
Signed: �.%� Print Name),/ rcd�L�(' ..., ����F �C• .�
Licensed Drain Layer
v�
Date•
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMrr REVISION 3/2018.doc
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TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION.
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BUILDING ADDRESS 7
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STREET
SUBDIVISION..
NORTH ARROW
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CONTRACT PRINT) NAME OF C NTRACTOR'S SUPERVISOR (PRINT)
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ST Eft ADDRESS SIGNATURE
6 DATE+ 00, 19-
TOWN STATE ZIP INSPECTED BY TOWN
( G` DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER