HomeMy WebLinkAboutDrain Layers Permits 17 Highland Drive 1900062 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 05/31/2019
GIS ID:42900017 w k FEE: 80.00
MUNIS APPLICATION# 201901081 :3 ,
� EXPIRATION DATE: 06/30/2019
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APPLICANT 3 .t LOCATION
NAME: JAMES THROWE DBA ADDRESS i17'T#IGILAND DRIVE
ADDRESS: 1330 MAIN STREET? ` s Qi L' BRIT (N NEIL&
` 1�fIIGILAND DRIVE
SOUTH WINDSOR,t,IQT*06 74%
PHONE 860 284 609-S �
WORK DESCRIPTION: NEW SLWEA CONNECT`I�hT-
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THE DRAIN LAYER ASSIGNED TO THIS TERNIT HAS A VALID LIEISE ISSUED BYYTI�E'STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FOR '11N H$ATTAC D`CO NDI IONS', L DRK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDAfD$;ALL OS11A REQLIRMEl*1TS,AND TEE ATTACHED CONDITIONS.
ISSUED BY DATE INSPECTED INSPECTED BY
5/31/2019 2:49 PM
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TOWN OF,SOUTHMINDSOR INSPECWN REPORT
PERMIT NO.._ CDNTMMR.
LOCATION: 7 V7: �� Yt
TYPE OF WQRK: W ' � ,
DATE INSP NEEDED: DATE INSP:.
INSPECTED
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PROGRESS:
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s/malloyg orms M14 Town of south Windsor MPSWM REPORT 14
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS : -1P 17
- STREET
SUBDIVISION:
777
NORTH ARROW
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CONTRACTOR (PRINT) NA OF CONTRACTOR'S,,`SUPERVISOR•(PRINT)
STREET ADDRES1S SIGN RE
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�' DATE
TOWN STATE ZIP INSPECTED BY TOWN
DATE
TELEPHONE NUMBER
WHITE — TOWN PINK — CONTRACTOR YELLOW — CONSULTING ENGINEER / DEVELOPER
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
Name of Firm: U111' >
Address of Firm:
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 Ze 3-S7
Existing Water Supply: Public Water_, Well
Proposed Start Date,�J4� a 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 '_�An'65 the holder of Drain
Layer's License No. 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: . - r 1
Licensed Drain Layer
Date: 29 /YPY l r
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT REVISION 3/2018.doc