HomeMy WebLinkAboutDrain Layers Permits 291 Pepin Place 1900051 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 05/08/2019
GIS ID: 70700291 ;,: FEE: 0.00
MUNIS APPLICATION# 201900890 EXPIRATION DATE: 06/07/2019
APPLICAN+ '`$ ,.. LOCATION
NAME: ATLANTIC EXCAVATIQN;INI" ADDRESS r191 PE IN PLACE
ADDRESS: 363 PARUM ROAD'At ` s i QSTR &N1$UILDING CO.,INC.
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10 BRt)OK STREET
COLCHESTER CT 0&' - k�
PHONE s+
WORK DESCRIPTION: NEW SWFO�NFCTr01v BITILDR�IG 14$O[ TH WI1VD60R WOODS
PERMITzF ?CQI.I,ETED Off�FPIsICArI'ON 20190Q884u
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THE DRAIN LAYER ASSIGNED TO ITI S q�ALTD L� ISE ISSCfi1:IJ ' �TH ,,STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORTH`iN THE e4TIaACHED I t71 DITI(31&: 'tks,L WORK SHALL BE IN ACCORDANCE WITH
THE TOWN Off'SOUTH WINDSOR STANDA1tDS,ALL OSHA REQUITtEMEI+f3 S,AND SHE ATTACHED CONDITIONS.
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TDVY OF-SOUTHVINDSORIpS ECYiON REPORT
PERMIT NO.: 1 CONTRACT'OR:
LOCATION;
TYPE OF WORK.
DkTE nVSP NEEQED: DATE INSP:
INSPECI`ED Bv: e
WORK.IN
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S/mollayirg"m Zi}14Town of South Windsor•M SS.TDOH
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: / e 73 T 7 W A/
Street No. Street Name ►%
Premises owned by: '
Name of Firm: _ �n.�7�rc Z�a 726-on Phone: ' c5 7C
Address of Firm:_ , _ _ r�.�vwc �C �� .tr 7`� C''7"� �� yk5
TYPE OF WORK:
Lay House Drain ; Repair House Drain Sanitary Disconnect
Lay Lateral for building with connection A_�_; or no connection ;
Lay Main
Lay Lateral for Commercial/Industrial Building number of acres
Connection will be made with C
Existing Water Supply: Public Water Well
Proposed Start Date Estimated time for completion
ALL WORK TO BE IN ACCORDANCE WITH TOWN OF SOUTH WINDSOR STANDARDS,
ALL OSHA REQUIREMENTS AND CONPITI&A ATTACHED TO THE PERMIT
Permit is to.be issued to the holder of Drain
Layer's License No. o�Rya,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. _121C-c�,9Y2 PLEASE NOTE:
IF A SANITARY SEWER LATERAL
IS WITHIN 75 FEET OF A WELL
IT MUST BE AIR TESTED
Sign d: 13
Print Name:
Licensed Drain yer
Date:_ _
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT REVISION 3/2416.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS : ��. /� —e?71 7Z5_ ?7P
STREET
SUBDIVISION: v
NORTH ARROW ?�
P-174- A-k-
74
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CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPERVISOR (PRINT)
STREET ADDRESS / SIG ATURE
?� Lam- l �,� ��� DATE
TOWN STATE ZIP INSPECTED BY TOWN
DATE
TELEPHONE NUMBER
WHITE -- TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER