HomeMy WebLinkAboutDrain Layers Permits 261 Pepin Place 1800096 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 12/07/2018 \ n
GIS ID:70700261
MUMS APPLICATION# 201802363 3 k `# FEE: 0.00
j }', TM s� ;tip EXPIRATION DATE: 01/06/20 i 9
APPLICANT ` OCATION
NAME: ATLANTIC EXCAVATI( irVC
a uDD�r , r2bJ PE PLACE
ADDRESS: 363 PARUM ROAD tiLttir� Gx � OWNER} rt �E" iJ DING CO INC
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t t 4 5 F� ri��� 1Q3ROI STREET
COLCHESTER,CT 0641'5
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WORK DESCRIPTION: NEW SEWER-CONNE'�G"�TI(���� irDI�GK,IS PFPIIN)�PLACIr f�{ �
FEE COLLTE�JSCN APIL 2018035
THE DRAIN LAYER ASSIGNED TO THIS PR 'II" A A I1T $N` ISSUED BY� IIIy* TTE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORTH �THE; TTACHED E ( 13IONS' ALi 4trSHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDAI At i CI9I3A.REQU `dVIENTS ANI TI ACHED CONDITIONS.
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ISSUED BY DATE Il PECM INSPECTED BY
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' TOWN OF SOUTH:W1140SOR 100 REPORT
PERMIT NO.. CONTA CrOR: r c i ry
LOCATION:
TYPE OF woAK:' :U
DAli INSP NEEDEt :' DATE IN R L 117 l 9
INSPECTED-By:
WOPW IIN
PROGRESS: L 6,', VC P—
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SEPTIC TANK.PUMPEC3y.SMASHED;FILLED. 'UUMESSED ❑YES NO'
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APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, Cr
f FEE $80.00
Location of proposed work: W C ' '.c
Street No. Street Name
Premises owned by:
Name of Firm: Phone: c _;
Address of Firm:
TYPE OF WORK: /
.Lay House Drain �, Repair House Drain , Sanitary Disconnect
Lay Lateral for building with connections or no connection
Lay Main._
Lay Lateral for Commercial/Industrial Building number of acres
Connection will be made with 7
Existing Water Supply: Public Water Well
Proposed Start Date Estimated time for completion
ALL WORK TO BE IN ACCORDANCE WITH TOWN OF SOUTH WINDSOR STANDARDS, f
ALL OSHA REQUIREMENTS AND CONDITIONS ATTACHED TO THE PERMIT
Permit is to.be issued to the holder of Drain
Layer's License No. 7 Only holders of P-1, P-7 or W-9 licenses
will be issued a permit. PERMIT WILL EXPIRE THIRTY(36) 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 j
Town Street Excavation Permit No. and/or ConnDOT Permit No.
CBYD No. _-xW e2n PLEASE NOTE:
IF A SANITARY SEWER LATERAL
IS WITHIN 75 FEET OF A WELL
IT MUST BE.AIR TESTED
Signed Print Name: � i.'�iS
Licensed Drain La
Date: l �`
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT REVISION 3/2018.doc I
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS
STREET : f -
SUBDIVISION: 4(�`
NORTH ARROW
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CONTRACTOR (PRINT) NAM 0 TRACTOR' SUPERVISOR (PRINT)
�Ic,73 ,Vex-qft 3� I
STREET ADDRESS SI ATURE
12 r4TE
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TOWN STATE ZIP INSPECTED BY TOWN
DATE �I
TELEPHONE NUMBER -
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER