HomeMy WebLinkAboutDrain Layers Permits 72 Longmeadow Drive 1900018 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 02/19/2019 fi F
GIS ID: 54670072 FEE: 80.00
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MUNIS APPLICATION# 201900288 EXPIRATION DATE: 03/21/2019
APPLICANT`. ' f4
LOCATION
NAME: SSC CONSTRUCTION ,LG ADDRPSS : ''72 LOTGMEADOW DRIVE
ADDRESS: I700 SAYBROOK 1073 ' V., OWNR �. {I OL LAND XVIII LIMITED PARTNERSHIP
} t F `42'OLDiRIDGEBURY ROAD
MIDDLETOWN,C O1f45
PHONE
WORK DESCRIPTION: NEW SVR CONNECTION r+, '1?
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THE DRAIN LAYER ASSIGNED TO THIIVPEIMI`I HAS A VI�DLTtENS$3ISSIJIvDBY TIE STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORTIT IN THIyxATTA WO `CQNI)ITI.Ol*IS' *21L VORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDARDS, 11>L OSIt1 REtJIRE11NTS,ACID TY3E ATTACHED CONDITIONS.
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ISSUED BY DATE INSPECTED INSPECTED BY
2/19/2019 8:33 AM
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TOWN OF SOUTH'.WINDSOR INSPECT N REPORT
PERMIT NO.: CONTRACTOR:
LOCATION: 7c 1,0'
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TYPE OF WORK: h e SU t? ir1�
DINE INSP N DAM INSP:_.,2, r 1 '
INSPECTED BY:
WORK IN
PROGRESS: ►4 ,&j �
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SEPTIC TANK PUMPED,'SMASHED. FILLED wrmESSED 0-YE5 [] No-
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INPUT: DATE: �� I [,,I\ F
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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: 7 Z Id-?I wke4ck� �.,� Lot #
Street No. Street Name
Premises owned by: -!:v►C--
Name of Firm: SS( &-0tfr,1c.tdn \(C— Phone: PGa 2tG-23�3
Address of Firm: 000
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 S0
Existing Water Supply: Public Water Well
Proposed Start Date Z• t s �°t 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. 0,7—F"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 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 .
Signed: Print Name:
Licensed Drain Layer
Date: 2--I S• (C
Standard Forms\Permits\APPLICA'tION FOR DRAIN LAYERS PERMIT REVISION 3/2018.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS 7
STREET
SUBDIVISION:
NORTH ARROW
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CONTRACTOR (PRINT) f NAME OF CONTRACTOR'S SUPERVISOR (PRINT)
STREET ADDRESS - SIGNATURE
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TOWN STATE ZIP INSPECTED B7 TOWN
DATE
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TELEPHONE NUMBER
WHITE — TOWN PINK — CONTRACTOR YELLOW — CONSULTING ENGINEER / DEVELOPER