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HomeMy WebLinkAboutDrain Layers Permits 101 Long Meadow Dri 1900038 TOWN OF SOUTH WINDSOR, CT PERMIT NUMBER DRAIN LAYER PERMIT nn DATE: 03/28/2019 GIS ID: 54670101 FEE: 80.00 MUNIS APPLICATION# 201900516 f ,1 EXPIRATION DATE: 04/27/2019 APPLICANT"r`fr LOCATION F NAME: SSC CONSTRUCTIC,?N L .0 } �DDRE8S t101 LONGMEADOW DRIVE ADDRESS: 1700 SAYBROOK I�QAI ' t7yUNER QI,L SAND XVIII LIMITED PARTNERSHIP 4 „ �70 1VIIDDLETOWN AVE MIDDLETOWN,C? Q6457: ?' PHONE r WORK DESCRIPTION: NEW AnW CCtNNZCTI�N 'y S i THE DRAIN LAYER ASSIGNED TO THT PEvIIT IAS A SAL ID LG$EISF,IS$UED:BY T)I$ISTATE AND HERESY AGREES TO ALL THE TERMS AND CONDITIONS SET FORjIH'IN'I IiE,ATTAC3I3ED` p1�1DIINS yIZ 1V0RK SHALL BE IN ACCORDANCE WITH THE TOWN OF SOUTH WINDSOR STANDA $,"t1LL OSHA 12ECUIREIIRILNT$,#AITDiTFIE ATTACHED CONDITIONS. F' ISSUED BY DATE INSPECTED INSPECTED BY 3/28/2019 11:07 AM Rh NEk kil a ! t s' F Y $ t 9S �� li+S y •f t v 1 �, � s m lh j l p, a n F F ! v M ` TD1N OF SQIJTH-.WINDOR:INSIP REPORT PERMIC NO.: dL CONTRACTOR. LOCATION: TYPE OF WORK: DATE INSP NEEDED::� - DATE INSP: 3 �� �9 INSPECTED BY: WORK IN PROGRESS: - ir HED FIt:LED WrMESSED []YES 0 NO SEPTIC TANK PUMPEQ,5•NIAS . AS-BUILT:• � .,.:-- .. ? ,-%: DATE: INPUT:— Wmdsor•iN R ORT14 S/mflltoyjfarmsMl4TQ=0fSDUth PS N 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:_ 10 zur we-adU"J Lot # 2 a Street No. Street Name Premises owned by: 70 t i �J Cc-'5' �✓!�- Name of Firm: Phone: M. ZS'a.a-3 L� Address of Firm: (?a a r\ e--` TYPE OF WOR Lay House Drain r; 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 Well Proposed Start Date 3 28, lam+ 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 �G�vG fir,•���w� �. �� the holder of Drain Layer's License No. f1m ozflFl r 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. PLEASE NOTE: IF A SANITARY SEWER LATERAL IS WITHIN 75 FEET OF A WELL IT MUST BE AIR TESTED Signed: Print Name: ��^-► n Licensed Drain Layer Date: Standard Forms\Permits\APPLICATION FOR©RAIN LAYERS PERMIT REVISION 3/2018.doc TOWN OF SOUTH WINDSOR SANITARY SEWER LATERAL FIELD LOCATION DATE OF CONSTRUCTION: BUILDING ADDRESS -Z L) f STREET SUBDIVISION: ; NORTH ARROW tj r � 3 iFil i" VL oft 35 ko I)e �q",) CONTRACTOR (PRINT) NAM, < } CONTRACTOI,�,S SUPERVISOR (PRINT) STREET ADDRESS SIGNATURE Ig f ry DATE L��Ll� TOWN l f STATE ZIP INSPECTED BY TOWN DATE TELEPHONE NUMBER WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER