HomeMy WebLinkAboutDrain Layers Permits 257 Pepin Place 1800095 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 12/07/2018 . Y�
GIS ID: 70700257 �
yu 0 FEE: 0.00
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MUNIS APPLICATION# 201802362 2 ; �� Y ;Mjt0� $u EXPIRATION DATE: 01/06/2019
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APPLICANT f
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NAME: ATLANTIC EXCAVATI pl aiNgt �i 5, 1y AJ I ESS xn25'1 PE i�T PLACE
ADDRESS: 363 PARUM ROAD � `a fi f h . OWNER4 �`' ` wry BwUY DING CO INC
STREET
COLCHESTER,CT 064,J�5
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PHONE
WORK DESCRIPTION: NEW SEWER CO"WTIO�i1V BSI 41' PEPIhT'T�LA E 5 J
FEE COLLSVTEDVN:APPL 200150 7 r
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THE DRAIN LAYER ASSIGNED TO THIS PRMI �#iAS A1I 119110i'E IS7D BYtT STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORTIo r y HE ATTACHED 15, 0NS AIL f I 'SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDARDS;AtiL OSHA:RE�U 12 IVTS,AN, T K' ACHED CONDITIONS.
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ISSUED BY DATE INSPE ' ED INSPECTED BY
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PERMIT NO..--. CONTRACTOR: ) ° ' : n
LOCATION: �e-6 MCI
TYPE OF V1tgRK: ? '
DATE INSP NEEpE[ : DA7E INSP:. ► I J l B
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APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
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FEE $80.00
Location of proposed work: Lot # «
Street No. street Name
Premises owned by:
Name of Firm: z Zl, Phone: 6
Address of Firm:
TYPE OF WORK: /
Lay House Drain P, 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 withi{� 5
Existing Water Supply: Public Water v Well
Proposed Start Date Estimated time for completion j
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-- the holder of Drain
Layer's License No. -- 7 Only holders of P-1, R-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 -
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Signed Print Name:
Licensed Drain La
Date:
Standard Farms\Permits\APPUCATION FOR DRAIN LAYERS PERMIT REVISION 3/2018.doc
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TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: &
BUILDING ADDRESS
STREET : '{'�
SUBDIVISION:
NORTH ARROW
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71
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CONTRACTOR (PRINT) NAM 0 TRACTOR' SUPERVISOR (PRINT)
STREET ADDRESS �( SI ATURE
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TOWN STATE ZIP INSPECTED BY TOWN
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DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER