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HomeMy WebLinkAboutDrain Layers Permits 253 Pepin Place 1800094 TOWN OF SOUTH WINDSOR, CT PERMIT NUMBER DRAIN LAYER PERMIT DATE: 12/07/2018 1g 2 GIS ID:70700253 FEE: 0.00 MUNIS APPLICATION# 20I80236I EXPIRATION DATE: 01/06/2019 APPLICANT4t;LOCATION z NAME: ATLANTIC EXCAVATIQTIT � ApI�tE,�stiy` 2S pI PLACE ADDRESS: 363 PARUM ROAD E it N QER F i 1+'&w rNBE7i,DING CO INC I�, STREET COLCHESTER,CT 0645k F t ors t t + t` i y PHONE �� t� YS� `s r Z. 2 r 3 y f 45 � t s ') b WORK DESCRIPTION: NEW SEW) R C'bTIN$ I1 SIN�rF PF�pI14LA25, . FEES COL ON PL 201$'0 r z r � . THE DRAIN LAYER ASSIGNED TO THIS PT{ AS A3LILi L>1 S`E rSUi;D BYI` `5T `TE AND HEREBY AGREES TO ALL THE TERMS AND CONDITIONS SET FORTH Y,74W ,3 TACI{ED 0W. ,I�? TONS' AI;T SHALL BE IN ACCORDANCE WITH THE TOWN OF SOUTH WINDSOR STANDART ;ALI OSHA I�EQUYItF�MENfS A1k+1D T � �r�T�IACHED CONDITIONS. ti +S y' w � ISSUED BY DATE INPP✓CTD INSPECTED BY 12/7/2015 9.33 AM { zrs cw` w dx Ft , i? ✓3y' +y} T Y r T r s 4 S tF SS ti,. s1 34 l k x Z�vVK i * 1`iS":f•! i+r �' V Cg S;w ' yav' `a i7r Z ti i+ 4,�b'��rZ44v 3 ,m Ln 4 CC � •. Y k Z r; � x� 4:1 9H��� 4*Z h f3 F�t55 y"fff r M J" h Al l k 1 TOM OF SQ�IT�i.IA/INDSQR INSPECTYON REPORT PERMIT ND.: � L - -COMM :J4 Tla4hiL LOCAMN: 2 TYPE OF WORK:-- S-P h DAli I'NSP NEEDS[ : DATE INSP: 11� a INSPECCED BY: e WORK:IV PROGRESSs VC S P— ri+ ? . t z7S e I�lf �tc�•• `AV �y c✓r.s�e SEPTIC TANK PUMPE4,,SMASHED; F1LLE©. „ 1NITNESSED ❑.YES Q NO AS-BUILT• ' - , • . .. INPUT: DATE: �olta1►/fomts�.4TbWo ofSQuthlMitdSor•I{�1P�E R�POR1'14 E APPLICATION FOR DRAIN LAYER PERMIT TOWN OF SOUTH WINDSOR PUBLIC WORKS DEPARTMENT TOWN HALL 1540 SULLIVAN AVENUE e � SOUTH WINDSOR, CT FEE $80.00 Location of proposed work: 'j ��„c �� Lofi # u, /� Street No. Street Name Premises owned by: Name of Firm: c c C r n_c, Phone: t5 Address of Firm: �f C �s Cam- TYPE OF WORK: / Lay House Drain Y; 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 .__ G� Existing Supply:Water Su ! : Public Water v 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 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(30) DAYS AFTER DATE OF ISSUANCE. The undersigned Drain Layer hereby agrees to all the terrns 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. :a76/Si2'S 7,,9, PLEASE NOTE: IF A SANITARY SEWER LATERAL IS WITHIN 75 FEET OF A WELL IT MUST BE.AIR TESTED . Signed Print Name: / ` 7 j Licensed Drain La Date: /C// i� Standard Forms\Permits\APPUCA11ON FOR DRAIN LAYERS PERMIT REVISION 3/2018,doc i TOWN OF SOUTH WI N DSOR SANITARY SEWER LATERAL FIELD LOCATION DATE OF CONSTRUCTION: VL- -7 " Iq BUILDING ADDRESS Zvi Z�j Z� 2 STREET SUBDIVISION: � Th � v0�t�� �,) 3 _ NORTH ARROW - 1 cl f I 1 A ijr�M �i_ r[ - A k, T, 1 E I i T ► I � ; � 1 _ i � C' _ 2- � f E n CONTRACTOR (PRINT) NAM 0 TRACTOR SUPERVISOR (PRINT) �10 ST REET ADDRESS r SI ATURE �`I / TE - TOWN STATE ZIP INSPECTED BY TOWN � frl 7- [ q DATE TELEPHONE NUMBER WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER F