HomeMy WebLinkAboutDrain Layers Permits 80 Pierce Road 1900020 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 02/19/2019
GIS ID: 71400080 FEE: 80.00
MUNIS APPLICATION# 201900290 EXPIRATION DATE: 03/21/2019
{
"{
APPLICANT',;"'' -
: ;z LOCATION
NAME: EAGLE EARTHWORK SERU Q,DDRESS 80'PIFCE ROAD
ADDRESS: I01 N MOUNTAIN ROAb bWNR 'IVIANNARINO ROBERT E
xx.
rh 400 CHAPEL RD#3-F
CANTON,CT 06010
PHONE 860-695 2027
WORK DESCRIPTION: SANIT,4RYFAIh ;
rn, - -
THE DRAIN LAYER ASSIGNED TO THI PERMIT HAS A V E;ISSiTED,BY TIDE STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORTH`5lIN THE ATTACHED`C4ND)TIONS' 'kLL 4ORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDARDS,, L OSHARE(UIIIEMENT$,i4IaTU THE ATTACHED CONDITIONS.
lloq
ISSUED BY A E INSPECTED INSPECTED BY
2/19/2019 11:31 AM
i
3 :
1
ti
JV
trE •�,y
AF s
Av
K 4 k 1
f
i
>4
..
j
I
TOWN
OF SOUTN•.WINWO►R INSP�EC IZO REPORT
PERMIT NO.: LO0 CONTRACTOR._ ----
LOCATTON. �Ct
TYPE OF WORK: .
DATE INS?NEEpED; DATE INSP: / 19
INSPECTED BY: . D
WORK.IN
PROGRESS.,
SEPTIC TANK PUMPED,5MASHtD, FILf.ED :WITNESSED ❑YES El NO
AS-BUILT...' '
I P ►�• � DATE;_ � � t�i
S/.6%wpow.2014 Town of South Windsor IIVP'S��Cif1N R�PGli7'14
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: �� Lot #
Street No. Street Name
Premises owned by:
Name of Firm: ` C Phone:• Via '" �
.. ,. -
Address of Firm: � � A 6POt 7
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 — c Estimated time for cornpletion
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 ~�V d the holder of Drain
Layer's License No. �L -2 /C _. 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. I � _� PLEASE NOTE:
IF A SANITARY SEWER LATERAL
IS WITHIN 75 FEET OF A WELL
/ IT MUST BE.AIR TESTED .
Signed:
zex%-/4�/f Print Name: / CIc
°
Licensed Drain Layer
Date:_
Standard FormsWermits\APPLICATION FOR DRAIN LAVERS PERMIT REVISION 3/2018.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS : ® �. Ile
STREET
oy SUBDIVISION:
NORTH ARROW
- -
l�
-
CONTRACTOR (PRINT) NAME OF C. NTRA1R'S SUPERVISOR (PRINT)
/
STREET A DRESS S# NATURE r'
DATE
TOWN STATE ZIP INSPECTED BY TOWN
DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER