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HomeMy WebLinkAboutDrain Layers Permits 133 Northview Drive 1900061 TOWN OF SOUTH WINDSOR, CT PERMIT NUMBER DRAIN LAYER PERMIT DATE: 05/28/2019 GIS ID:64500133 FEE: 80.00 MUNIS APPLICATION# 20190105$ t .; EXPIRATION DATE: 06/27/2019 APPLICANT' .f' LOCATION NAME: JAMES THROWE Dt��y ADDRS 1 `N RTHVIEW DRIVE ADDRESS: 1330 MAIN STREETS4 kBONZ �TI FRANK P JR "` rvx,� r..• 1 }NO THVIEW DRIVE Y,-) F.. Et SOUTH WINDSOR5bik6607 rt ni 4 ; fy PHONE 860-289 00�5 F< WORK DESCRIPTION: REPAI1HaCJ5EQ�2IAN ; v r. b THE DRAIN LAYER ASSIGNED TO THIS PERMIT HAS A VALID L1Ir'EJSI ISSIJ1;11$Y I STATE AND HEREBY AGREES TO ALL THE TERMS AND CONDITIONS SET FORVF°`IN THE THE `C(�NDIT1©NS' A�Lr�1�CORK SHALL BE IN ACCORDANCE WITH THE TOWN OF SOUTH WINDSOR STANDA> S,AI;L DSIJA'R1aQUIREMENTS Al*1D TIE ATTACHED CONDITIONS. h i i a ISSUED BY DATE INSPECTED INSPECTED BY 5/28/20 1 9 2:12 PM y�4 y r k a ••. ,d,t� � G �, r Yt YS y 33 t h k t 1 y t. s 1' 1Ni!OF SOUTN".WINDSORINSPECIM REPORT PERMIT NO.: (P1� CONTRACTOR:- _I LOCATION! TYPE OF WORK: DATE INSP NEEI?Ea�, DAIS 1NSP; i INSPEGTED-BY:—; L- WOW IN R� c PROGRESS; - 3� Cv-v.,s l-e SEPTIC TANK PUMPEQ,_SMASHED, FILLED V ITNESSED YES [] NO AS-BUICT• PIZ INPUT: '�t DATE:�� S/mollo)f1%,ms 2014TOM of South Wn�dsorINPS N tt PORT 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: �u,41, U{ > _Lot # Street No. Street Name Premises owned by: !�2 1 rZ(, Name of Firm:_ can Phone:�� 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 j Existing Water Supply: Public Water < Well Proposed Start Date�301A_65 Estimated time for completion ymi i 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 va-e,,; t r n the holder of Drain Layer's License No. JA-Q`�' 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. Wit /0(�2 25 _ PLEASE NOTE: IF A SANITARY SEWER LATERAL ' IS WITHIN 75 FEET OF A WELL IT MUST BE AIR TESTED Signed:- ��^- l /'�L`-'L-- Print Name: Licensed Drain Layer Date: = /1/1 0 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 I STREET SUBDIVISION: NORTH ARROW ` I , + . CONTRACTOR (PRINT) NAME OF CONTRA OR'S SUPERVISOR (PRINT) STREET ADDRESS SI TURE � ,J7ATE TOWN STATE ZIP INSPECTED BY TOWN DATE TELEPHONE NUMBER WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER