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HomeMy WebLinkAboutDrain Layers Permits 54 Lipman Drive (2) 1900022 TOWN OF SOUTH WINDSOR, CT PERMIT NUMBER DRAIN LAYER PERMIT DATE: 02/27/2019 fl GIS ID:53700054 r MUNIS APPLICATION# 201900336 F FEE: 80.00 EXPIRATION DATE: 03/29/2019 tit APPLICANT t`k NAME: INCORPORATED INDUSTRIES LLC LOCATION ADDRES�S� 54 LII MAN DRIVE ADDRESS: 180 W NEWBERR*aU` O S TH JEFFREY J&MARY C R MI 54 LIP1„1!IAN DRIVE BLOOMFIELD, CTilOAS®02 133I x k y PHONE 860-24 01 17 V i ` y( y!= WORK DESCRIPTION: NEW S)uWONNECTTON ` )` 5...•,r .� > k 1 THE DRAIN LAYER ASSIGNED TO THIS PEII YIi� HAS AMAEID 1 G�E1�S IS5I�ED$ THE STATE AND HEREBY AGREES TO ALL THE TERMS AND CONDITIONS SET FORTH`IN.nI.M. T Iiq 13E) �C"O ITZ©NSA '&L*ORK SHALL BE IN ACCORDANCE WITH THE TOWN OF SOUTH WINDSOR STANDt1ID5,E\LL OSHA REQTFIREIINTS,AND TI TE ATTACHED CONDITIONS. ISSUED BY DATE INSPEC 2/2720I9 9:45 AM TED INSPECTED BY t - 7 04 1�i1. r q1 F2 3t 14. n5 ;t t k � TOWJN OF SOUTH".Wi'INDSORINSPECOON REPORT PERMIT NO.: I 00 oa CONTRACTOR:_ c �� a ncq LOCATION: L M TYPE OF UVORK: CQ r DATE INSP NEEDED: DATE MP: L19 INSPECTED WOO IN PROGRESS:_ SC I� /'' itc3 iL vc'I 6ek-ck—ol _.. � _. ,� .aim c... �� �[C'i�r L��� �2. ' . . .��- ' •fa . r/ NO SEPTIC TANK PUMPEQ;SMASHED, FxU.ED „ 1�IIIIVESSED r .YES ❑ AS-BUILT• ' •' DATE: \c� ... Vm6ilayfforms 2M4 Town of South Windsor ri�iP�ON 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: - �f L),P,�''� '�� '� —Lot # Street No. Street Name Premises owned by: 1 1 Name of Firm: l��� � �c�:� , �,. v� Phone: Address of Firm: TYPE OF WORK: Lay House Drains; 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 2 11Y 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 �' 1�'�� � _N '�a�'��` the holder of Drain Layer's License No. Zu,p(o 6 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. 2 U C)jOi �% 1 PLEASE NOTE: IF A SANITARY SEWER LATERAL w4 IS WITHIN 75 FEET OF A WELL IT MUST BE AIR TESTED Signed: w Print Name: �, y? _c� `lam . Licen d Drain Layer Date: Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT REVISION 3/2018.doc TOWN OF SOUTH WINDSOR SANITARY SEWER LATERAL FIELD LOCATION DATE OF CONSTRUCTION: 4 Vk Nvc,t\ \� "-I L BUILDING ADDRESS STREET : _Ll7. SUBDIVISION: NORTH ARROW ►`' „ter t A - -- - -; - Z. I I � ; i j � � I � '�• I ' CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPERVISOR-(PRINT) STREET ADDRESS SIGNATURE DATE J. TOWN STATE ZIP INSPECTED BY TOWN �} —1 C)1 t s — DATE TELEPHONE NUMBER WHITE — TOWN PINK — CONTRACTOR YELLOW — CONSULTING ENGINEER / DEVELOPER