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HomeMy WebLinkAboutDrain Layers Permits 271 Pepin Place (2) 1900046 TOWN OF SOUTH WINDSOR, CT PERMIT NUMBER DRAIN LAYER PERMIT DATE: 05/08/2019 ` GIS ID: 70700271 k MUNIS APPLICATION# 201900884 FEE: 80.00 s k � EXPIRATION DATE: 06/07/2019 APPLICANT % LOCATION NAME: ATLANTIC EXCAVOIC N INS ADDRESS 71 PA IN PLACE ADDRESS: 363 PARUM ROAD &W BUILDING CO.,INC. 110 BROOK STREET COLCHESTER,CT;'pq 155 Y, J PHONE t S WORK DESCRIPTION: NEW SnWFI C01FNCTION FOR BUILDING 1 ;SQUTT'VINDSOR WOODS S THE DRAIN LAYER ASSIGNED TO THISi,PEI IIT HAS A l!ALID I IV134 'E ISSUEIJ�13Yk STATE AND HERESY AGREES TO ALL THE TERMS AND CONDITIONS SET FORTII''IN IIE.ATTACHI;D` M 4jD T QN84'• ALL CORK SHALL BE IN ACCORDANCE WITH THE TOWN OF SOUTH WINDSOR STANDAtDS AI.L OSHA`REQIIIREMENTS AID T. E ATTACHED CONDITIONS. Moll ISSUED Y DATE INSPECTED INSPECTED BY 51=019 10:49 AM r _ y *—gft f U vbr'Vi ql.f as p r I ysi r:. tip i f k TOW1 OF SQUTI.ININQSQR=MSPEC'QDN REPORT . - . � ;- • . . � � ; inn coNTR,kc o PERMIT NO.: f/ LOCATION; r TYPE ©ATE INSP NEEDED: = GATE INSP: INSPECCED WORK-'.IN PROGR � �775 e r�c� SEPTIC TANK PUMPED,SMASHED, FILLED WrMESSED El YES 0 NO AS-BUILT. • -. . . INPUT: DATE: S/maltaq/famns 2014 Tavm of South Wtftdsor•riVPSkTiON REPORT 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: ;'? Street No. Street Name �� Premises owned by: Name of Firm: �rc .� �.� Phone: V;9-6 Address of Firm:__3:;:' ? I aZlc r e /��X �..lr,ly 7` , C-71. (nC AXI TYPE OF WORK: Lay House Drain ; Repair House Drain • Sanitary Disconnect Lay Lateral for building with connectlon�r no connection Lay Main Lay Lateral for Commercial/Industrial Building number of acres Connection will be made with 5� 1315• f `ra Existing Water Supply: Public Water Well Proposed Start Date S Estimated time for completion �c ALL WORK TO BE IN ACCORDANCE WITH TOWN OF SOUTH WINDSOR STANDARDS, ALL OSHA REQUIREMENTS AND CON ITIO ATTACHED TO THE PERMIT Permit is to be issued to - _ _ the holder of Drain Layer's License No.alo�ff;Y ,'. - . 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 ref l 9 Sind: Print Name: Licensed Drain yer Date:— Standard 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 : .' /y �����2 P?7P Fly -23?,, `2Rl STREET SUBDIVISION: �v � �- INN*.- NORTH ARROW I ; R I � I--- I ��f�... s � ,� j i - - -�-- _ mm t� � c f1 1 i 22ntT '� CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPERVISOR (PRINT) STREET ADDRESS // SIGNATURE TOWN STATE ZIP INSPECTED BY TOWN DATE TELEPHONE NUMBER WHITE — TOWN PINK - CONTRACTOR YELLOW — CONSULTING ENGINEER / DEVELOPER