HomeMy WebLinkAboutDrain Layers Permits 98 Longmeadow Drive 1900056 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 05/20/2019,
GIS ID: 54670098 FEE: 80.00
MUMS APPLICATION# 201900997 �„ EXPIRATION DATE: 06/19/2019
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APPLICANT .`' LOCATION
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NAME: SSC CONSTRUCTION LLC' Z ADDRESS 98 ONGMEADOW DRIVE
ADDRESS: I700 SAYBROOK NO, OWNER BOLL RAND XVIII LIMITED PARTNERSHIP
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OL RIDGEBURY ROAD
MIDDLETOWN,Cf 06451;:
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PHONE
WORK DESCRIPTION: NEW SEWER 0QECTION s`
THE DRAIN LAYER ASSIGNED TO THI PEVIIT HAS A,VA ID ICENSI ISST�JED BY TI3L STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FOnH`M.ITE WORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDtDS,AI L OSHA:RI;QUIRENIENIS,ANp TIDE ATTACHED CONDITIONS.
ISSUED BY DATE MPVCTED INSPECTED BY
5/20/2019 12:11 PM
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TO1N vF SQ1J7 H.INYNDSflR INSPEC'�N REPORT
PERMIT NO,4
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DATE INSP NEEDED` = DATE INSP:
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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 #
Street No. Street Name
Premises owned by: it 01of _;P7 C —
Name of Firm: JS',C &' S i roc. 1 ( (-- Phone:eq�- 2 r°. 23 t 3
Address of Firm: ( oc) Are-ati /7 e�2
TYPE OF WOR
Lay House Drai ; 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 � Safi
Existing Water Supply: Public Water_ Well
Proposed Start Date S Z (• f � Estimated time for completion r�1
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 SF 1 ��''� �''`""`" '� a' the holder of Drain
Layer's License No. X*-'� OZV- '4 ��°� . 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. �Oe-(3 r PLEASE NOTE:
IF A SANITARY SEWER LATERAL
IS WITHIN 75 FEET OF A WELL
IT MUST BE.AIR TESTED
Signed: Print Name: ��t�� ��•"" 'I'a
Licensed Drain Layer
Date: ,;5-, ZO-
Standard Forms\Permits�APPLICATION FOR DRAIN LAYERS PERMIT REVISION 3/2016.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: :' of
BUILDING ADDRESS —
STREET -
SUBDIVISION: 4S.,&&L C,7-�
TNORTARROW Cam=-•
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CONTRACTOR (PRINT) NAME OF COWRACTOR'S SUPERVISOR (PRINT)
STREET ADDRESS SIGNATURE
TOWN STATE ZIP INSPECTED BY TOWN
2 .3 I DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER