HomeMy WebLinkAboutDrain Layers Permit 0255 Avery Street (2) 1800078 TOWN OF SOUTH WINDSOR, CT
PExMiT NUMBER DRAIN LAYER PERMIT
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DATE: 10/26/2018
GIS ID: 06300255
FEE: 0.00
MUNIS APPLICATION# 20180211.8 1. EXPIRATION DATE: 11/25/2018
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APPLICANT rz ix. OCATION
NAME: RED TECHNOLOGIES LVQ,, ADII 25 AVE Y STREET
ADDRESS: 10 NORTHWOOD DR.IV PAQrU) �,I'E WILFRED M TRUSTEE
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R� STREET
BLOOMFIELD,CT 0600'2'
PHONE " fi
WORK DESCRIPTION: AVERY S Is,, CON"ft TTQ i PI�Q7Ei�;1 NQ F Ek
2 LATERA`�,l�i E T ND ED jFOR FU'I C7 E VII bING OTS r k(,
THE DRAIN LAYER ASSIGNED TO THIS P rRI IM I-T,.- A Vr E D I,ICi1NSE 1SSU1rI3 BY TB TATE AND
THE TERMS AND CONDITIONS SET FORTH ., HEREBY AGREES TO ALL
ilk HE ATTACHED`GOIDITIONS' ALLaRI SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDARD$,*LL OSTit, HA REQUIREMENTS,AN17 TI A ACHED CONDITIONS.
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ISSUED BY DATE Mff6WD
INSPECTED BY
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TOWN OF SOUTH'.WINDSOR INSPFECRON REPORT
PERMIT NO.: CONTRACTOR:_
LOCATION
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TYPE OF WORK: A V f - G��
DATE INSP NEEDED,.,_._;. DATE INSP: 2 h—1
INSPECTED BY: cat ::>— "
WORKIN
PROGRESS: i�.� n i�r��i:S - �.��rr� Mqv. in �t-)��s S .LC i
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SEPTIC TANK PUMPED,'SMASHED, FILf.ED rvl/� WITNESSED ❑-YES [] NO'
AS-BUIE.T: '
INPtjT: DATE:
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S/molloy/tbm M14 Tom of South Windsor.INPbEt'Tft REPORT 1.4
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: /west S—\ Lot #
Street No. Street Name
Premises owned by:
Name of Firm: ZZ h� +Qx-W tj cAo 6, LL Phone: �B6o f 2.4'18
Address of Firm: JD h b� \r ,Q.�+zl �. , 0600-'.
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 Q• ��� 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 �2� i the holder of Drain
Layer's License No. PLA,coat✓ ia6.Q _. 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: � ` 2 �✓ �f�F
Licensed Drain Layer
Date: (0-n- 1t6
Standard Farms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT REVISION 3/2016.dac
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: Z/,&,
BUILDING ADDRESS
STREET .
SUBDIVISION:
NORTH ARROW
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CONTRACTOR (PRINT) NAME OF CONTRAC OR'S SUPERVISOR (PRINT)
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STREET ADDRESS SIGN
DATE
TOWN STATE ZIP INSPECTED TOWN
.. DATE
TELEPHONE,NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS
STREET
SUBDIVISION:
NORTH ARROW
WL
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CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPERVISOR (PRINT)
STREET ADDRESS SIGN,T
DATE
TOWN STATE ZIP INSPECTED BY T WN
--ZIP•2.k7
DATE
TELEPHONE NUMBER ^
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER