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HomeMy WebLinkAboutDrain Layers Permits 105 Beldon Road (2) 1900040 TOWN OF SOUTH WINDSOR, CT PERMIT NUMBER DRAIN LAYER PERMIT t. DATE: 04/08/2019 ,00l ` GIS ID: 09300105 FEE: 80.00 MUNIS APPLICATION# 201900593 /,`gAil ` T EXPIRATION DATE: 05/08/2019 Fl APPLICANT t : LOCATION } NAME: JAMES THROWE D$' ,t ; ADDRESS rOS B1{,DON ROAD t 'A_ B1I1ZERR' ICHARD& ADDRESS: 1330 MAIN STREE BEIIDON ROAD SOUTH WINDSOR Cs 00i , G y PHONE 860-28 0095- :, k'WORK DESCRIPTION: REPAI14HOWE Dn it ,RrAIN } r, THE DRAIN LAYER ASSIGNED TO THI pFI IIT HAS A�Vt LIUEI SE ISSUED BY THIS STATE AND HEREBY AGREES TO ALL THE TERMS AND CONDITIONS SET FOR I?I'I1�1 TI#E N i�eC.Y�D`fiQ1 DIT O IS' 'ALL WORK SHALL BE IN ACCORDANCE WITH THE TOWN OF SOUTH WINDSOR STANDAIL L OSI�A'RTj(��lIIIEM)�NTS,;A1+1'D TETE ATTACHED CONDITIONS. DATE INSPECTED INSPECTED BY 4/8/2019 8:48 AM ISSUED BY z 4r �• F R ^Yt .. vy ; v x � M1 �s sr•`y! {� yF5 J i I }h ti h; it+"j kr ut i ry FJ s v' y s f t S` i h ` y � a� F<Y' v kp T1. +.• r v A �! Sk f� I I 1 TOW1 ©F SOUTN�ININWOR INSPECION REPORT 0(-j el PeRmrr NO.: �© CONTRACTOR: LOCATION. , Type OF WORK. ' EDED: DATE INSP: v r� DATE INSP NE -: . . INSPECTED-6rf: '��. W09K.IN . PROGRESS:.�� �. �,.. :�.�►�. • . Lw• � . . Wn�NEssED []-YES, C]NO SEPTIC TANK PUMPED,5 SHAD;FILLED INPUT: c AFL^- $/maf[oy/forms 2014 Town of South Wutdsor•INPSt+CCfiON REPOR714 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:_ 1 U &Ijc�ln _Lot # p - Street No. Street Name Premises owned by:__L��_LJ U� c, Name of Firm:_/ ,,e Phone: �16 Address of Firm: /, L aco n mil. 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 Well Proposed Start Date I� Estimated time for completion E14 K 1 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 ����rnc,S J(/I ter)tA/� the holder of Drain Layer's License No. 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. C�O I l PLEASE NOTE: IF A SANITARY SEWER LATERAL IS WITHIN 75 FEET OF A WELL IT MUST BE AIR TESTED Signed: G Print Name: icwx,5 ,r�>w1 Licensed Drain Layer Date: s /,�2 � l� Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT REVISION 3/2018.doc TOWN OF SOUTH WINDSOR SANITARY SEWER LATERAL FIELD LOCATION DATE OF CONSTRUCTION: 19L12 - BUILDING ADDRESS STREET ICA 0 0 rc-.0 SUBDIVISION: NORTH ARROW —T J .......... ..��_ � �� i - ' -___�_•_ ..� P 1 III' - ` ' S U-C, 3 \c�YY�t-cS L� �y-cam CONTRACTOR (PRINT) NAME OF CONTRACT 'S SUPERVISOR (PRINT)- 1330 mesh S , y O STREET ADDRESS SIN TURE f C T TOWN STATE ZIP INSPECTED BY TOWN DATE TELEPHONE NUMBER WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER