HomeMy WebLinkAboutDrain Layers Permit 0164 Avery Street 1800080 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 10/26/2018 f
GIS ID: 06300164 65.
j, FEE: 0.00
MUNIS APPLICATION# 201802120 r „ ° EXPIRATION DATE: 11/25/2018
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APPLICANT ' .;k r r yi LOCATION
NAME: RED TECHNOLOGIES I IrC�hy y rl kh_ t ADDRESS 164 AVERY STREET
ADDRESS: 10 NORTHWOOD DRIV s. Np Y OWNER (} A iS N LARRY D&KERRIE P
164VI�RIt STREET
BLOOMFIELD,CT 0602 rf s {
PHONE
WORK DESCRIPTION: AVERY STREET REf�QNSTRTJC�IOl`�11�E�i�JEC�T
THE DRAIN LAYER ASSIGNED TO THIS PT�RN4Z��' S A VAt'ID IrIC'$N SSUED BY THI~STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORTH tN 1110 TTACHED 3QON tTTI.ONS" I L V ORI SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDARI ,AL L OSIA REQL�SREMEI�J:TS;ANC TL1.�1T'IACHED CONDITIONS.
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ISSUED BY DATE INSPECTED INSPECTED BY
10/26/2018 9:40 AM
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TOINJN OF SOUTH,.WXNDSOR INSP OPTIION REPORT
PERMIT'NO.: t) CONTRACTOR:
LOCATION: ✓ 5'
TYPE OF WORK. Ian
DATE INSP NEEDED: DATE INSP:
INSPECTED
WORK.IN '
PROGRESS: j�jr-F-WALk-
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INPUT: ' DATE: + °
SIm6110Y&M 2014 Town of South NOW 1NP5EPM kPORT 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: k -
:; - 5V Lot #
Street No. Street Name
Premises owned by:
Name of Firm: Phone: B6b-,i8-Z�129
Address of Firm: to
TYPE OF WORK:
Lay House Drain ; Repair House Drain ; Sanitary Disconnect
Lay Lateral for building with connection ` t ; 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�� Estimated time for completion �� `'6
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 dbnt'c�� the holder of Drain
Layer's License No.IkA.c)W i v6c> 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:
b ed Drain Layer
Date:r , s\ -\,t6
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT REVISION 3/2018.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: '`- - �i --
BUILDING ADDRESS : ! ✓ 4
STREET
SUBDIVISION:
NORTH ARROW
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CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPERVISOR (PRINT)
to
STREET ADDRESS SIG
DATE
TOWN STATE ZIP INSPECTED BY TOWN
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DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER