HomeMy WebLinkAboutDrain Layers Permits 41 Good Hill Road 1900043 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 04/24/2019
GIS ID: 36000041 r OXIA FEE: 80.00
MUNIS APPLICATION# 201900760 t EXPIRATION DATE: 05/24/2019
�"
APPLICANT z I LOCATION
NAME: JMB PLUMBING LLCt ADDRESS ,• 41"GOQD HILL ROAD
ffi
ADDRESS: 19 KENTON STREET rw r' OWNER ; rSAlI,1G0 KRISANDRA TRUSTEE
y',GOOD HILL ROAD
KENSINGTON,CT11.00097�
h 3
PHONE
r1 S.. w rp r
WORK DESCRIPTION: CONN#-CTQ POOI^HC)USE TO EX5TII �� I��VE v
, ai
THE DRAIN LAYER ASSIGNED TO THI&PERMIT HAS STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FOH`1N TIlt;ATTACBED`C`OND IT.I:ON
ft S' ALL 1�VORK SHALL BE IN ACCORDANCE WITH
T14E TOWN OF SOUTH WINDSOR STAND ` S,ALL OSHp:REQUIREM1viVTS,AI I:D TSIE ATTACHED CONDITIONS.
ISSUED BY DATE INSPECTED INSPECTED BY
4/24/2019 12:14 PM
t a
q' 4
r
:
i
M
i
TOYI1 OF SQUTN.W�NDSQRINSPiECn4N REPORT
PERMIT NO.: D04
c CONTRACTOR..
k
LOCATION.. L`
TYPE OF INQRK:
DATE INSP:.
DATE INSP NEEDED'
'f
INSPECTED
WORK.IN
.�- ;,,, K.l J c
PROGRESS. ,
co
FILLED I UNESSED ❑YES, [I NO'
SEPTIC TANK PUMPED,SMASHED, .
AS-BUILT'
DATE:._.._
woitoyAonns ZDf4 Town aP Scuth Windsor 3NP'S K 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: I I Lot #
Street No. Street Name
Premises owned by:
Name of Firm: Phone:
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 5-/2 12_ 3 5- e-1�t
Existing Water Supply: Public Water V Well
Proposed Start Date 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 letSo A &rs�l,?r cTM� b'65"the holder of Drain
Layer's License No. -P1 . 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: ON sEUE
Licensed Drain Layer
Date: 9
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT REVISION 3/2018.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: v
BUILDING ADDRESS
STREET : ��% =�l( 'Zl
SUBDIVISION:
NORTH ARROW
i __...._..... _.. _ __;
0 i&) e-1z pf-, C,(r 44)--
CONTRACTOR (PRINT) AME OF CONtZR'S SU RVI OR (PRINT)'
STREET ADDRESS SIGNATU
DATE
TOWN STATE ZIP INSPECTED BY OWN
_ �► C�C'_. C i DATE
TELEPH E NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER