HomeMy WebLinkAboutDrain Layers Permits 295 Pepin Place 1900031 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 03/21/2019
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GIS ID: 70700295 ,= FEE: 80.00
MUNIS APPLICATION# 201900457 EXPIRATION DATE: 04/20/2019
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APPLICA ITT LOCATION
NAME: ATLANTIC EXCAV TON ING tDDRESS 2 PLAIN PLACE
ADDRESS: 363 PARUM ROADtK 8cI�$UILDING CO.,INC.
Fu 110 BROOK STREET
COLCHESTER,C10�4"I5 t; y
PHONE ,
WORK DESCRIPTION: NEW SQVER4�CICTYOIV I+OR BUTLDIl�(G'1eSOUTI +UVIIVDSOR WOODS
THE DRAIN LAYER ASSIGNED TO THIS PEW1 HAS A ,4LID LICIyN$E:ISSUEb<B 5{TIDE STATE AND HEREBY AGREES TO ALL
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ETERMS AND CONDITIONS SET FORTH"Ili;ffik T ACI ED`G01Vj]ITI TS; ?4 L GVORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDWS,,ALI OSHA REQUIRE11 1V CS,.�IYI.D THE ATTACHED CONDITIONS.
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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: jc; 3g�jo 31S ✓''�� Lot # /`J,
Street No. Street Name ,�_p,,L RA-C
Premises owned by:
Name of Firm: -��
a ILL Phone:
Address of Firm: �,� �� - 6 'X115-
TYPE OF WORK:
Lay House Drain ; Repair House Drain ; Sanitary Disconnect
Lay Lateral for building with connection —7-Itor no connection ;
Lay Main
Lay Lateral for Commercial/Industrial Building number of acres
Connection will be made with r�' �'X'3 5 t/C
Existing Water Supply: Public Water v Well
Proposed Start Dates /r' 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. c�,Zo 3ey Y -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. -,002,P/00 0 XC 7 PLEASE NOTE:
IF A SANITARY SEWER LATERAL
IS WITHIN 75 FEET OF A WELL
IT MUST BE.AIR TESTED .
Signe . Print Name:"
Licensed Drain er
Date: 120
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT REVISION 3/2018.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION:
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STREET
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TOWN STATE ZIP INSPECTED IrY TOWN
DATE
TELEPHONE NUMBER
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