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HomeMy WebLinkAboutDrain Layers Permits 151 Clinton Drive 1900044 TOWN OF SOUTH WINDSOR, CT PERMIT NUMBER DRAIN LAYER PERMIT n f DATE: 04/30/2019 GIS ID:21300151 Y FEE: 80.00 MUNIS APPLICATION# 201900792tY y t' ; ``5; EXPIRATION DATE: 05/30/2019 49 APPLICANT LOCATION NAME: CORREIA EXCAVA`0RS ING ADDRESS I51 CAINTON DRIVE OW ADDRESS: 101 PROGRESS DRTVF s} £„ 1VMARGARET M yw r ;1` 1 CL&TON DRIVE MANCHESTER,C1 Q601r ry �� PHONE WORK DESCRIPTION: NEW SEWE �a y;y+n THE DRAIN LAYER ASSIGNED TO THI'k'p5 ✓If'I;1PAS A W7i in LiCI;1�I�S ISSIi 0 B 'TI-�E STATE AND HEREBY AGREES TO ALL THE TERMS AND CONDITIONS SET FORT�I TNtI ATTAC#�ED �CC3NDI ZO TS '4117i;ORK SHALL BE IN ACCORDANCE WITH THE TOWN OF SOUTH WINDSOR STANDAI DSO hL L(3SIJIREMENTS A'NID THE ATTACHED CONDITIONS. ISSUED BY DATE INSPECTED INSPECTED BY 4/30/2019 11:56 AM �r x t Syv �,uv r a ,rRV a v�r ,ea mu' y ,. s"'t r�s ,.I,...s"! .t r N art 1 +,, ' � � +: tSF,`"v y CS s 4�s�� W".,...•„ �+ ' bk Rik }, ai �{^+,1YA 5 rid y, +� t irr 1 TOWS OF SQUTH.ININDSORINSpEG'UO N REPORT . .9dD CONTRACTOR:- ��� PERMIT NO... LOCATION: CP Il TYPE OF WORK: DATE INSP NEEDED: DATE INSP: 5 INSPECTED BY: 6 S� WORK,IN PVC a PROGRESS: C9 K "` I, F..: . 1VICNESSED [],YES NO* SEPTIC TANK PUMP�FD;SMASHE©, FILLED AS-BUILT' $/molloylb ms 2U4 TO=of South Windsor riVPS�N IMPORT 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. N1 C/,'*-A,--� l�i^s'l�� Lot # Street No. Street Name Premises owned by: Name of Firm. Phone: 6s� Address of Firm:-/c / %� r� rs /OG .� �- � TYPE OF WORK. Lay House Drain ; Repair House Drain ; 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 ( S Dk - Existing Water Supply: Public Water Well Proposed Start Date y-°� -/� 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.PIJV.v,z-1�36-Y-R,2. 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. O 19 i 70 3ErO PLEASE NOTE; IF A SANITARY SEWER LATERAL IS WITHIN 75 FEET OF A WELL IT MUST BE AIR TESTED Signed Print Name: ��- Licensed Drain Layer Date: Standard Forms\Permits\APPLICATION FOR BRAIN LAYERS PERMIT REVISION 2017.doc TOWN OF SOUTH WINDSOR SANITARY SEWER LATERAL FIELD , LOCATION DATE OF CONSTRUCTION: BUILDING ADDRESS STREET : C LT_N—j o SUBDIVISION: NORTH ARROW Mal. Isfi / r / CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPERVISOR (PRINT) .° r•-o c `-�.s s � mow.'_....... _ ,, STREET ADDRESS SIGNATURE DATE C TOWN STATE ZIP INSPECTED BY TOWN .',� . ter'' f c� - �✓/r�- DATE TELEPHONE NUMBER WHITE — TOWN PINK - CONTRACTOR YELLOW — CONSULTING ENGINEER / DEVELOPER