HomeMy WebLinkAboutDrain Layers Permits 315 Pepin Place 1900035 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 03/21/2019
GIS ID:70700315 FEE: 0.00
MUNIS APPLICATION# 201900464 y EXPIRATION DATE: 04/20/2019
APPLICANT
, s LOCATION
NAME: ATLANTIC EXCAVT�ON1N1 ADDRESS 033 PAIN PLACE
ADDRESS: 363 PARUM ROAD." 1IUILDING CO.,INC.
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gi 16 BROOK STREET
COLCHESTER CT�'0041�5�, 'f�`
PHONE
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WORK DESCRIPTION: NEW SEW zt kCn FOR BUIEI�II�TG [JTI J$VINDSOR WOODS
PERMIT,F E CO M CTED id1�t A�'PI;I ATYON 20;I11im
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THE DRAIN LAYER ASSIGNED TO THIS PERMIT f#A5 <L�CE1�Ts�E 1SSU D BY T1fE STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FOR'.IT fK THE..ATTAC.IE6.`CfJNAL3 0 1 ,' LL. UORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDARDS,[L L OSHA XtEQUIREIy�EhiTS,YA1TD ZfIE ATTACHED CONDITIONS.
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TOWS OF SOUTH
PERMIT N REPORT
PERMIT N0, l 5 CONTRACTOR:
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TYPE OF WQRK: � . 2
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DATE INSP NEEDED; DATE TNSP:
INSPECTED BY:
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S/malloy/forms 2014 Town of Souib Wtndsor•IMPSk ON kptgT 14
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: WX r jai 3a jo 9 31-f 3`2S Lot # �3
Street No. Street Name �,;L RAC!
Premises owned by: ;1 I Z Co .
Name of Firm: � Phone: a �
Address of Firm:
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 ��� c�✓,J�,� ���
Existing Water Supply: Public Water Well
Proposed Start Date �� /i' Estimated time for completion - 21
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 c G, the holder of Drain
Layer's License No. a ass 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 K
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. <3 _A�7 PLEASE NOTE:
IF A SANITARY SEWER LATERAL
IS WITHIN 7S FEET OF A WELL
IT MUST BE-AIR TESTED .
Signe . Print Name:-- Z=2
Licensed Drain L er
Date: o y
Standard Farms\Permits\IPPLICATION FOR DRAIN LAYERS PERMIT REVISION 3/2018.doc
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TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: -
BUILDING ADDRESS �� �� �
STREETS=�?�A
SUBDIVISION: �� S
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CONTRACTOR PR#NT) NAME OF CO OR'S SUPERVISOR (PRINT)
STR ETA DRESS SI TUR
ATE
TOWN STATE ZIP INSPECTED TOWN
� �d yqo DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER