HomeMy WebLinkAboutDrain Layers Permits 9999 Miller Road 1800046 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 06/12/2018 k
GIS ID:59709999 � rwU FEE: 0.00
MUNIS APPLICATION# 201800942 t' VW." EXPIRATION DATE: 07/1212018
APPLICANT� r t { — �. '' T3{ ...v. 5 LOCATION
NAME: B&W PAVING&LA SrCA IITiG ,,5 y� z `1 APDRE�Pr M ITJ�Bi ROAD
ADDRESS: P O BOX 70 ti a�3 }� � �F x3cy Y�W1F€ k �pWw F SOUTH WINDSOR
MYSTIC,CT 06355 SU LIVAN AVE
01R�INDSOR, CT 06074
PHONE 1-860-5 1 9 42 r
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WORK DESCRIPTION: MILLER41t0 p 7S E T NSION PR(1�EC TO RSI JJECT NO FEE
BETWEE BRi( ITh+1AN DII CU EAST O1�f M rLEI Rb D SEE TOWN PLANS
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THE DRAIN LAYER ASSIGNED TO THIS�EL�I�IIAS A U .�I?�z��x`r�a;�SSUET�t$Y'�TIk�STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FOR'1?;.A"HE AT=TAGI E I N?I I OI S' All,"W: RK SHALL BE IN ACCORDANCE WITH
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THE TOWN OF SOUTH WINDSOR STANDA dS; �'OSII I E T�TI1tEME 1tT5,AN T E ATTACHED CONDITIONS.
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ISSUED BY DATE INSPECTED INSPECTED BY
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APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT �0
TOWN HALL
1540 SULLIVAN AVENUE 1"
SOUTH WINDSOR, CT
FEE $80.00
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Location of proposed work: Lot #
Street No. Street Name
Premises owned by: M4jer Rd Se►t/eL g-14. Sew Lawn Alaiy
. 1
Name of Firm: G� � ����� Phone:
Address of Firm: 7c� S% `;L— v' t 3 �
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
Some rno5A
Existing Water Supply: Public Water, _ �_ Well
Proposed Start Date G' o�S /quo Estimated time for completion �7 W2e-k-S
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 e-(//Vl czP I the holder of Drain
Layer's License No. ALP) , 04 8V W-2_-f'7. Only olders 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. �2 0 36 cqr f PLEASE NOTE:
IF A SANITARY SEWER LATERAL
IS WITHIN 75 FEET OF A WELL
IT MUST BE AIR TESTED
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Signe Print Name: P n 5.e a,
License brain.L er
Date:—
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Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT REVISION 3/2018.doc
Print Lookup Details Page 1 of 1
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State of Connecticut
Lookup Detail View
Name and Address
Name Address
KEVIN T EDGERLY 42 pine street
columbia, CT 06237
Credential Information
Effective Expiration
Credential Credential Type Date Date States
PLM.0286492- PLUMBING & PIPING LIMITED 11/01/2017 10/31/2018 ACTIVE
P7 CONTRACTOR
Generated on: 6/7/2018 9:20:51 AM
httns://www.elicense.ct.gov/Lookup/PrintLicenseDetaits.aspx?crcd=1053 808&contact=91641 6/7/2018