HomeMy WebLinkAboutDrain Layers Permits 309 Pepin Place 1900034 TOWN OF SOUTH WINDSOR, CT
PEWAIT NUMBER
DRAIN LAYER PERMIT
DATE: 03/21/2019
GIS ID: 70700309
MUNIS APPLICATION# 201900463 r Y Al"a' FEE: 0.00
a"' EXPIRATION DATE: 04/20/2019
APPLICAh]T t ' '
NAME: ATLANTICEXCAV �IQ INC uk
LOCATION
;N ADDRESS 3U9 PI*PIN PLACE
ADDRESS: 363 PARUM ROADt OR fi a
tT
&:M UILDING CO.,INC.
Lt,10 BROOK STREET
COLCHESTER, C*64151
PHONE
WORK DESCRIPTION: NEW SFW R O CTIiDN FO BCJII.D (',`13;Sf�iJTH�VINDSOR WOODS
PERMIT*FLE CQLLC I`EDN APPLTCA ION 2Q 1�004Sk'
THE DRAIN LAYER ASSIGNED TO THISS PT., , H 4S A VALTD tI 'I✓1�1SE,ISSUFD g THE STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FOR'�H`11V fi$E ATTACIED`CONDZ�XO tS'1 L L.[�ORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR 8TANDtIpS,1iLL OSHA REC�UIIZEMENT ,A1x}D IE ATTACHED CONDITIONS.
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ISSUED BY DATE INSPECTED
3/21/2019 2:27 PM INSPECTED BY
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Towim OF SOUTHMINbSOR INSVECODN REPORT
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PERMIT NO
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LOCATION:__�_____
TYPE OF WoR*
• • • Da�EINSP:
DATE INSP NEEQED:
INSPECTED-BY:
WORK.IN
PROGRESS: L'o M. -.. �' s :3
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AS-BUILT: � -
INPUT: DATE: '
5{mclSaylfiomns 2014 Taws of SouNt Windsor lNPS .'120N 1�EPaRT 14
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APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
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PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $80.00
Location of proposed work: W?� 3g5 �3o 9 air 3'eS Lot #
Street No. Street Name � ,;t
Premises owned by: -7�4 Co .
Name of Firm: A c �t-t Phone: St-0
Address of Firm: r,
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 � 3 VC
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Existing Water Supply: Public Water Well
Proposed Start Dates /y 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, / � �F,�- the holder of Drain
Layer's License No. c�?a jigs y Only holders of P-1, R-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 k
Town Street Excavation Permit No. and/or ConnDOT Permit No.
CBYD No. 2-022?1=0 a XC 7 PLEASE NOTE:
IF A SANITARY SEWER LATERAL
IS WITHIN 75 FEET OF A WELL
IT MUST BE.AIR TESTED .
Signe e- -W2l Print Name:_ , ,
Licensed Drain er
Date: o
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMrr REVISION 3/2018.doc
TOWN OF SOUTH WINDSOR
" SANITARY SEWER LATERAL FIELD LOCATION
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DATE OF CONSTRUCTION: c) -
BUILDING ADDRESS ° �`� ►
STREET -
SUBDIVISION:
NORTH ARROW ' 7 Q qq
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CONTRACTOR,,�PRINT) NAME OF CO OR'S SUPERVISOR (PRINT)
STR ET A DRESS SI TUR
ATE
TOWN STATE ZIP INSPECTED IrY TOWN
DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER