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HomeMy WebLinkAbout175 Oakland Rd - Drain Layer Permit (2) 1800059 TOWN OF SOUTH WINDSOR, CT PERMiT NUIv1sER DRAIN LAYER PERMIT DATE: 08/14/2018 GIS ID:65700175 y 4 r y FEE: 80.00 MUNIS APPLICATION# 201801427 fYn ,r:, `t ;�y �F yell 5tiva �C EXPIRATION DATE: 09/13/2018 {,f APPLIC LOCATION NAME: GERBER CONSTRUCTI9;N 9Oj ADDRE S 17 OA LAND ROAD ADDRESS: I NUTMEG DRIVE aEi Yj �( ATCH III LLC � f $ CiTIVE DRIVE SUITE 100 ELLINGTON CT 061'6s �`��' =�" ' ' �A �� t PHONE 860-8756b8 a RM WORK DESCRIPTION: BERRY PA�T�I-�iIIR "L T, Fyr w'�f YL °f�� 7 d :e CONNECTr (sHAiGrE PA ]�FOIrit20� 00292, r THE DRAIN LAYER ASSIGNED TO THIS EWT`tHV A ll L1!✓ N� I f ISSU I�' Yk I TATE AND HEREBY AGREES TO ALL THE TERMS AND CONDITIONS SET FOR 1iI1 IIE I T.XCII�`C�bNi7ITI,q-TSt7ji AL W(dRK SHALL BE IN ACCORDANCE WITH THE TOWN OF SOUTH WINDSOR STANDA�RDS,�ALI,,,,06HA 1-QIiIIRMEI�[T. ,ANI TIATTACHED CONDITIONS. ISSUED BY DA E INSPECTED INSPECTED Y 8/14/2018 2:16 PM Z {yss g x wj �.444Y„sy It>� YY f J. GjK�u',� ki • `� far � r, `-x ;��; ti�t t��iY � ��Y��r,,�� } ��� a, . TOWN OF SOUTH WINDSOR INSPECOON REPORT PERMIT NO.: `� �� "� CONTRAMR... e c +� LOCATION: J-7Y z kad* X aad TYPE OF WORK'- i� I. NY' �� DATE INSP NEEDED: DATE INSP: INSPECTED BY: I WORK IN PROGRESS: SEPTIC TANK PUMPE®, SMASHED, FILLE© � WrMESSED ❑YES 0 NO AS-BUILT: INPUT: DATE: S/molloy/forms 2M4 Town of South Windsor MPSEMON REPORT 14 ' I 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 5' 04 k LR N D fz Lot # Street No. Street Name Premises owned by: �0'2 rY Name of Firm: 7[P , J Phone: 9 V Address of Firm: u� TYPE OF WORK; Lay House Drain ; Repair House Drain ; Sanitary Disconnect Lay Lateral for building with connection ; or no connection Lay Maln Lay Lateral for Commercial/Industrial Building number of acres Connection will be made with Existing Water Supply: Public Water Well ®� f � `� 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 o �� �� F ��- the holder of Drain Layer's License No. 0 Z 09 41 Z - �� �_. 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. Nand/or ConnDOT Permit No. i Z0jP07 0115 7 CBYD No. PLEASE NOTE: IF A SANITARY SEWER LATERAL IS WITHIN 75 FEET OF A WELL IT MUST BE AIR TESTED Signed: Print Name:_l,y�s L' a sed Drain Layer Date: b h Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT REVISION 3/2018.doc