HomeMy WebLinkAboutDrain Layers Permits 325 Pepin Place 1.900036 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 03/21/2019 _::
GIS ID:70700325 x7
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MUNIS APPLICATION# 201900465 ;iP pil?,' t t EXPIRATION DATE: 04/20/2019
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APPLICA 'T`, ` s f LOCATION
NAME: ATLANTIC EXCAV ,TIOl�INC Q�DDRESS 35 PEPIN PLACE
ADDRESS: 363 PARUM ROADY
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3UILDING CO., INC.
1O BROOK STREET
COLCHESTER,C10641
PHONE �, x
WORK DESCRIPTION: NEW SWI4V2 C VINDSOR WOODS
PERMIVEE COLLET TES 7N AP LZ A ON 2Gl,0045?
THE DRAIN LAYER ASSIGNED TO THI$PERMIT H U0D;B TES STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORIyITiV THE ATTACHED`GQNDITIQNS'� ALI *ORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDAli�DS,1�LL OSHA REQUIR1;1kIEI�iIfi,,lIk7D TfiE ATTACHED CONDITIONS.
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ISSUED BY DATE INSPECTED INSPECTED BY
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TOWN OF SOUTH-.WIN RINSI�EC'ixON REPORT
PERMIT NO, / 900CY36 CONTR [CTQR: �`
LOCATION,_,.__DY
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DATE INSP NEEQE .
[SATE INSP.
INSPECTED BY:
WORK:IN
PROGRESS:
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DEPORT 14
S/molla�q/Pomns2014Town of South Wsndsor INPS ON
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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: -0s`Jam'; 3cd 7o 2 3%-f X.zs Lot #
Street No. Street Name ��,:� RA-c c-
Premises owned by:
Name of Firm:__ -z7c Phone:
Address of Firm:__2C,3
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 Weil
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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, �- � ��r� ,� _ the holder of Drain
Layer's License No. 4=1WT y —P 7 . Only holders of P-1, F-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. 22, a XC 7 PLEASE NOTE:
IF A SANITARY SEWER LATERAL
IS WITHIN 7S FEET OF A WELL
IT MUST BE.AIR TESTED .
Signe Print Name:
Licensed Drain L er
Date: o
Standard Farms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT REVISION 3/2018.doc
TOWN OF SOUTH WINDSOR
SANITARY SEINER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: z r
BUILDING ADDRESS �� �`� l ►
STREET
�Q,�: 94-C -
SUBDIVISION:
NORTH ARROW
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CONTRACTOR PRINT) NAME OF CO OR'S SUPERVISOR (PRINT)
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STR ET A DRESS SI TUR
ATE
TOWN�/ STATE ZIP INSPECTED TOWN
()if q(—) DATE
TELEPHONE NUMBER
WHITE -- TOWN PINK — CONTRACTOR YELLOW — CONSULTING ENGINEER / DEVELOPER