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HomeMy WebLinkAboutDrain Layers Permits 102 Longmeadow Driv (2) 1.900045 TOWN OF SOUTH WINDSOR, CT PERMIT NUMBER DRAIN LAYER PERMIT DATE: 05/02/2019 GIS ID: 54670102 " FEE: 80.00 MINIS APPLICATION# 201900822 EXPIRATION DATE: 06/01/2019 �r r — s APPLICAN,Tf LOCATION NAME: SSC CONSTRUCTI hLC ADDRESS j02 LONGMEADOW DRIVE ADDRESS: 1700 SAYBROOK is OWNEyR k' O�.L i=AND XVIII LIMITED PARTNERSHIP OLD' IDGEBURY ROAD u � s t MIDDLETOWN,CT Q-m` ' PHONE WSWOR{DESCRIPTION: NEW Ys; fir' K t �l' THE DRAIN LAYER ASSIGNED TO THI ,PEk1V1I1 HAS A VALID)INSE ISSUE,A B �I`I STATE AND HEREBY AGREES TO ALL THE TERMS AND CONDITIONS SET FOR`II"TN THE,ATTAC.ID` (NDI I.CJIS';"'." L CORK SHALL BE IN ACCORDANCE WITH THE TOWN OF SOUTH WINDSOR STANDARI)StIL OSHA'R$QCJIItEME1I`I7�ATD THE ATTACHED CONDITIONS. s `k ISSUED BY DATE INSPECTED' INSPECTED BY 5/2/2019 3:51 PM Al iz ez � J k 1 4 t ). �* 4 t:, S 1. 1FF: f 6 TO1N #©F SQUTH.INYNQSQRINSECnON REPORT PERMIT NO.: P1 0 0 0 Y CQN'CRACTOR: LOCATION: L- TYPE OF WQRK: DATE INSP NEEDED` DAIE INSP:, ' ' � INSPECTED•BY: .4R- . WORK:IN PROGRESS: O1 A• x . Ic- SEPTIC TANK PUMPtp,•$MASHED, FILLED . .. WITNESSED []YES NO AS-BUILT• INPt�T: DATE: S{m6114y/6ams 2M TO=of sou&Windsor MPSOC116M NEPOW 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: Lot # Z K Street No. Street Name Premises owned by: 76\,` +Q�5. IAC- Name of Firm: SAC Cc,AS irc)d (\ Phone: 66'0.2,ro.z313 Address of Firm: t 70O.'�zy biW A, ftQ r1A,rgy tQ 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 1�'tf'DfI, Existing Water Supply: Public Water Well Proposed Start Date S.Z. i 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 the holder of Drain Layer's License No. Pl-m Dz F?rtl f 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. Zd PLEASE NOTE: IF A SANITARY SEWER LATERAL IS WITHIN 75 FEET OF A WELL IT MUST RE.AIR TESTED Signed: Print Name: . r� fi���,+-, �• Licensed Drain Layer Date:,�, 2. ( i Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT REVISION 3/2018.doc TOWN OF SOUTH WINDSOR SANITARY SEWER LATERAL FIELD LOCATION DATE OF CONSTRUCTION: BUILDING ADDRESS ' STREET l do i,l SUBDIVISION: 6 o i-44 NORTH ARROW lei .AL w, IF ..�....- -- -�.. A�.+�{ CONTRACTOR (PRINT) NA E OF- OgTRACTOR'S Sil RVISOR (PRINT). STREET A RESS SIG ATURE DATE To STATE ZI'P INSPECTED BY TOWN J?6, 5� DATE TELEPHONE NUMBER WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER