HomeMy WebLinkAboutDrain Layers Permits 37 Schoolhouse Driv (2) 1900024 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 03/05/2019
GIS ID: 81200037 FEE: 80.00
MUNIS APPLICATION# 201900354 z EXPIRATION DATE: 04/04/2019
APPLICAl!STT LOCATION
NAME: EAGLE EARTHWOP SER`V, ADDRESS 37 SCHOOLHOUSE DRIVE
ADDRESS: 101 N MOUNTAIN A15`" Y. OWNER A%N N RINO BUILDERS INC
CHAPEL ROAD UNIT 3-F
CANTON,CT 0601
PHONE 860 6907 �
WORK DESCRIPTION: NEW SEWER QI"T ECTION' RY,Vnh
THE DRAIN LAYER ASSIGNED TO THIS P1yr tMIT HAS A VAX.I13);ICEhF,.ISSLfI,I�:BY T STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FOR'�H"IN TITEATTAGHED�C;ONDITI.QNS , AI L WORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDA. S,ALL OSHA`REQXJII2EMENAT*ID TIIE ATTACHED CONDITIONS.
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TOWN OF SOUTH. OR INSPECTION REPORT
. I gQ00d y CoNTRAcroR:
PERMIT NO. .
LOCATION:
. .. TYPE OF WQRK: LL�
DATE INSP NEEDC[ ; DATE INSP:
INSPECTED BY:.
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PROGRESS: ��w�rz. .i���-- �°,.�ti��rrl�. 'a� i-�-�'� ��,�^�w'�t�� •
SEPTIC TANK PUMPED,.SMASHED, FILLED WITNESSED ❑-YES � No
AS-BUILT: '
INPUT: DATE: '
S/moltoy/fbrMs 2ai.4 Town of South Windsor•3NPSkjtt4 Rbg7'14
APPLICATION FOR DRAIN LAYER PERMIT 4
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $80.00
Location of proposed work: 3`7 � C- _Lot #
Street No. Street Name
Premises owned by: C)
Name of Firm: � 6 T L bi 0� � - � `��-r Phone: ,
Address of Firm: �� ��"� � t44 /( !
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 �" 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. ? 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: �� r
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT REVISION 3/2018.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD. LOCATION
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DATE
TOWN STATE ZIP INISPEQTD BY TOWN
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TELE HONE NUMBER
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