HomeMy WebLinkAboutDrain Layers Permits 175 Oakland Road (3) 1800021 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 04/10/20I 8
GIS ID:65700175
MUNIS APPLICATION# 201800380 FEE: 80.00
EXPIRATION DATE: 05/10/2018
APPLICANT LOCATION
NAME: GERBER CONSTRU TION CO AI?DRESS 1 TSmOAKLAND ROAD
ADDRESS: i NUTMEG DRIVE OWNER $EtYPATCH III LLC
ELLINGTON,CT 0G��9 - 6 EXECbTIVE DRIVE SUITE 100
1a
FAIWTNGTON,CT 06032
PHONE 860 87 �6684
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WORK DESCRIPTION: NEW SE CONNECTION FOR BERRY PATCH III ' r
BUILDING(7}741 7.Q4(TO BE INSTALLED IN THEALL'OF 2018)
THE DRAIN LAYER ASSIGNED TO THISERMIT HAS A yALTD LICENSE ISSUED BY THE'STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORTkj IN THE',ATT:ACHED`CONDITI:QNS' ,AEI WORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDAIS L OSHA REQiJIREMENTS,AIx1b THE ATTACHED CONDITIONS.
ISSUED BY DA E SPECTED �SPECTED BY
4/10/2018 12:29 PM
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: CONTRACTOR: G`slfv��eY
LOCATION: - Cce- 6 on cA
TYPE OF WORK: {f LO sew e�. co n n�ec-bon
DATE INSP NEEDED: DATE INSP: l !v !,V^ i
INSPECTED BY. 3 e, €
WORK IN I
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PROGRESS: a r 3P DC ,-)L -+ iL-rf r-AR¢lc.,
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SEPTIC TANK PUMPED,SMASHED, FILLED WITNESSED ❑YES ❑ NO
AS-BUILT: v' t
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INPUT: C, DATE: ,.
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S/mo(loy/forms 2al4 Tom of south Windsor INPSWMN REPaRY 14
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APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT `
TOWN HALL
1540 SULLIVAN AVENUE'S~ �\
Q SOUTH WINDSOR, CT
FEE $80.00
Location of proposed work: 1'7 S 6-4<+--4a r0 Lot # LD S
Street No. Street Name
Premises owned by: err
Name of Firm: /be /41dyo (c)r Phone: R60
Address of Firm: C &xecJvf- ?,d fivW11x t, . CT 0603-L
TYPE OF WORK:
Lay House Drain ; Repair House Drain
La Lateral for building with connection
Y g or no connection
Lay Main
Lay Lateral for Commercial/Industrial Building number of acres
I
Connection will be made with To rn c o 1
Existing Water Supply; Public Water__ Well I
Proposed Start Date 3 #q re 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 6�et6,r Co;%- (vA ^ �+
� c- the balder of Drain
Layer's License No. P7 . 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. 201�b 70 19 5` Ll 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
I
Date:_
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT REVISION 2017.doc
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TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: AA"
BUILDING ADDRESS
�vi�L��iuGs
STREET
SUBDIVISION:
NORTH ARROW
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CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPERVISOR (PRINT)
STREET ADDRESS "SIGNATURE
st[lI Lf N DATE
TOWN STATE ZIP INSPEC TOWN
&sc>- S- ( C' - DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER