HomeMy WebLinkAboutDrain Layers Permits 305 Pepin Place 1900033 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 03/21/2019 Y
GIS ID: 70700305AW, FEE: 0.00
MUNIS APPLICATION# 201900461 EXPIRATION DATE: 04/20/2019
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APPLICANT t� x
r LOCATION
NAME: ATLANTIC EXCAd' 2TIQAJ t1�IC ADDRESS 305 P'PIN PLACE
ADDRESS: 363 PARUM ROAD,`^ OWNER T ,M"BUILDING CO.,INC.
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x BROOK STREET
COLCHESTER,CT@00415G
PHONE r 4 4 1 Y" `Mai
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WORK DESCRIPTION: NEW SBW� INECTIaNFOR$iyILDI1Ck 10> T�I fWINDSOR WOODS
PERMITSFEE C�?LLCTEI� APPLICATION 1Q19Q045 '
THE DRAIN LAYER ASSIGNED TO THI <PI;IMIT HAS A 9iLTT)LACEISR::IS$U1✓DBY SHE STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FOI�tfi�1'INaTE.�iTTAG�HED `GQNDICINS' t3RLL WORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDAItD5, 4LL OSHA`RE UIR$1IF11 S,AND;THE ATTACHED CONDITIONS. .
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ISSUED BY DATE INSPECTED INSPECTED BY
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TOWS� SQII'r'N.WIN�R�INSP'EMON REPORT
PERMIT N0. I. 0Q0a CON7RACT4R.
LOCATION:
.mc OF WQRK: �} .c.�
40 A0
DATE
DATE INSP NEEDED:
INSP:
INSPECTED BY:
WORKAN
PROGRESS' Lis l _
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SE�TC TANK PUMPEQP,S HED, PILLED
WITNESSED ❑YES [] NO-
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INPUT: �� • � . .
$jmoilo)fj%m ZM4Town of South Windsor YNPS=MN REPORT 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: Jc,� 3os,�6 9 3/S 3Z T Lot #
Street No. Street Name
Premises owned by: �- co .
Name of Firm: -r��� , Phone: � �
Address of Firm: " �,� �� -- X/s
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 ��
VC
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Existing Water Supply: Public Water Well
Proposed Start Date / /.9 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 , / Z n;„ D�- j c—_the holder of Drain
Layer's License No. o -ass Z - P 7 . 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 receivedIr
Town Street Excavation Permit No. and/or ConnDOT Permit No. k
CBYD No. _ �1,P1CO 0 "C 7 PLEASE NOTE:
IF A SANITARY SEWER LATERAL
IS WITHIN 75 FEET OF A WELL
IT MUST BE-AIR TESTED .
Si ne . Print Name: Z
Licensed Drain L er
Date: �o
Standard Forms\Permits}APPLICATION FOR DRAIN LAYERS PERMIT"REVISION 3/2018.doc
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TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: I- )
BUILDING ADDRESS ZK 3elt SO`t —31c5 1 325
STREET
SUBDIVISION:
FORTH ARROIA&3
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CONTRACTOR PRINT) NAME OF CO OR'S SUPERVISOR(PRINT)
STR ET A DRESS SI TUR
'�. 31,
ATE
TOWN STATE ZIP INSPECTED TOWN
`t5 - 5�T-()ifq(-) DATE
TELEPHONE NUMBER
WHITE -- TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER