HomeMy WebLinkAboutDrain Layers Permits 33 High ridge road 1900027
PERMIT Ni TMBER TOWN OF SOUTH W I N D S O R, CT
DRAIN LAYER PERMIT
DATE: 03/12/2019
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GIS ID:42300033
MUNIS APPLICATION# 201900393 ` k
s EXPIRATION DATE: 80.00
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NAME: WASTEWATER 0#` I E %D$A Ipg LOCATION
ADDRESS; 21 COURTNEY D 7 G' D SS' 33'HI H RIDGE ROAD
F C�VNER `
:z`ROSSlr TO BARBARA J&RICHARD J
ELLINGTON,CT 0, 029 u 4 t i }� r Y r, 34 HIGH RIDGE ROAD
PHONE
WORK DESCRIPTION: Y`
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THE DRAIN LAYER ASSIGNED TO TFO P1 RIVIIT I qS VALID L ENSFhISSI7EI7 BY TEE STATE AND HEREBY q
THE TERMS AND CONDITIONS SET FOI 4H 1N I iE�ATTACXI$I? pNDITIOISS, WORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STAND t w AGREES TO ALL
ATDS, I,L 06I.4 RJa t1rRE S�AND THE ATTACHED CONDITIONS.
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ISSUED BY
3/12/2019 9:00 AM DAT PECTED SPECTED BY
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TOWN OF SOUTH"WWINDSOR'INSPECTION REPORT
PERMIT CONTRACTOR: h
LOCATION: 1 l G� f� a
TYPE OF WORK: .
DATE INSP NEEDED:_. DATE INSP:
INSPECTED BY: : .
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�/maftoyjfb ms 2014 To=of South Windsor•MPS6` Tft OEM*14
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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: 3 3 kb,6H 'P1-b6g 7z r� Lot #
Street No. Street Name
Premises owned by: o 5S17TO
Name of Firm: .s'lcrP,;7 4119%7-E4�)4rc:iz-- Phone:
Address of Firm:—;?-( C07,t 1z -rN C 0(Z-- e k- �--'%AJ 67Vr�
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 L• �� s���
Existing Water Supply: Public Water " Well
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Proposed Start Date Estimated time far 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. o z b-7 7 2 . Only holders of P-1 r 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. g v f 9 /°01 4-�Z 6 PLEASE NOTE:
IF A SANITARY SEWER LATERAL
IS WITHIN 75 FEET OF A WELL
IT MUST BE AIR TESTED
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Sign Print Name:
L censed Drain Layer
Date: r(r 9
Standard Forms\Permits\APPLICAIION FOR DRAIN LAYERS PERMIT REVISION 3/2038.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS 3 -3 KA RiAne rd
STREET
-� SUBDIVISION: -
NORTH ARROW.
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CONTRACTOR (PRINT) NAME OF CON,RACTQ 'S UPERVISOR (PRINT)
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STREET ADDRESS IIINIATTE
Pextc� � _ .� DATE
TOWN STATE ZIP 1115500 BY TOWN
DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW -- CONSULTING ENGINEER / DEVELOPER