HomeMy WebLinkAboutDrain Layers Permits 85 Longmeadow Drive 1900016 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 02/06/2019
GIS ID:54670085 '
MUNIS APPLICATION# 201900245 0 !.k, FEE: 80.00
EXPIRATION DATE: 03/08/2019
APPLICANT
1 LOCATION
NAME: SSC CONSTRUCTION LLC POiGMEADOW DRIVE
ADDRESS: 1700 SAYBROOK ib0 ,' x OWN R OLL LAND XVIII LIMITED PARTNERSHIP
41
MIDDLETOWN, CT 0645 s ` �OLDyRIDGEBURY ROAD
PHONE
WORK DESCRIPTION: NEW SWER COII`ECTIO1Vi
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THE DRAIN LAYER ASSIGNED TO THfS P>~RMIT TEAS Ay`!A ID LEISEaISSUET7 BY ' STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORS H'IN ETIIE ATTAG�IEp ONDI IOlaiS' ALL;WORT{SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDARDS ALL`pSHA REQZ)IREM$IiTS,AIVD T1IE ATTACHED CONDITIONS.
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ISSUED BY
DATE INSPECTED INSPECTED BY
2/6/2019 9:53 AM
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TOWN OF SOUTH[WINDSOR INSPECI'IOW REPORT
PERMIT NO.: DAD/� CONTRACTOR:
LOCATION: 1
TYPE OF WORK: c,�� S� � ►� Y� n
DATE INSP NEEDED., DATE INSP.— a � `r
INSPECTED
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slmalloy/forms 2014 Town of south windsor'INPstcridN REPORT 14
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: r-S L0,-7- lj.e12cJ&f1 OfrVC- ` Lot # /7
Street No. Street Name
Premises owned by: rorl 7,s4�
Name of Firm: �fC Cons�r�4� t Phone:
Address of Firm: t 0c-J Sat yv/V&Ak n17 C�6`ef-Z
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
Existing Water Supply: Public Water Well
Proposed Start Date z• 6• f Estimated time for completion G r
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 s�<<^�-'��--���~^ the holder of Drain
Layer's License No. Off,0Z#P'7 8"If . 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. zot`1� 3 PLEASE NOTE:
IF A SANITARY SEWER LATERAL
IS WITHIN 75 FEET OF A WELL
IT MUST BE AIR TESTED .
Signed: Print Name: -5 t L- -r—�- Cc-,-
Licensed Drain Layer
Date;
Standard Forms\Permits\APPLICAIION FOR DRAIN LAYERS PERMIT REVISION 3/2018.doc
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SANITARY SEWER LATERAL.
DATE OF CONSTRUCTION:
BUILDING ADDRESS 1.7
SUBDIVISION:
NORTH ARROW
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CONTRACTOR (PRINT) NAME CONTRACTOR'S SUPERVISOR (PRINT)
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STREET ADDRESS SIGNATURE
c r l DATE
TOWN STATE ZIP INSPECTED BY TOWN
{' DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER