HomeMy WebLinkAboutDrain Layers Permits 287 Pepin Place 1900050 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
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DATE: 05/08/2019
GIS ID: 70700287 n
FEE: 0.00
MUNIS APPLICATION# 201900889 k LL=4 EXPIRATION DATE: 06b7/2019
APPLICANT .; °
M LOCATION
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NAME: ATLANTIC EXCAVf;jQ 1h1C ADDRESS 287 PITIN PLACE
ADDRESS: 363 PARUM ROAD;LOWNPR T&
r , a 51V..BUILDING CO.,INC.
1'10 BROOK STREET
COLCHESTER,CT100,415 2k x "
PHONE z�
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WORK DESCRIPTION: NEWS WI; Q.0 CTION BUILDING 14 SOT TI ��VI TDSOR WOODS
PERMIT B COLLEETED( NAP.tCTAT`ION209Q`(7$84'
THE DRAIN LAYER ASSIGNED TO THISiP$RitrIIT Hq5 A Y.4T.lIy LICIyNS$ISSUY;DY ICI STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FOR"IHT1�I,4%`�iT'I'ACHED CONDITIONS' I,L WORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDARDSr AItL OSI�A'IfEQi1IREMNTS,AND TF1E ATTACHED CONDITIONS.
ISS ED JW DATE INSPECTED INSPECTED BY
5/8/2019 11:23 AM
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DATE INSP N 'Eb O: DATE INSP:
INSPECTED BY:
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S/moltayJforms 2014 Town of South Windsor 1NpS ION REp$RT 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:
Street No. Street Name X.
Premises owned by: `
Name of Firm: �' l��w.�'frc .� ,�,1� `e.� fir, Phone: G6"�?3t'
Address of Firm: 31,3 C,/,r x7<e C-71
TYPE OF WORK:
Lay House Drain ; Repair House Drain • Sanitary Disconnect
Lay Lateral for building with connection�r no connection ;
Lay Main
Lay Lateral for Commercial/Industrial Building number of acres
Connection will be made with
Existing Water Supply: Public Water Well
Proposed Start Date S 5 Estimated time for completion
ALL WORK TO BE IN ACCORDANCE WITH TOWN OF SOUTH WINDSOR STANDARDS,
ALL OSHA REQUIREMENTS AND CON .ITION ATTACHED TO THE PERMIT
C.l Xv 7--tAcur
Permit is to be issued to the holder of Drain
Layer's License No.(:yc RyzTy - 7 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
Sign d: Print Name:
y
Licensed Drain yer
Date:
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT REVISION 3/2018.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION:
Ar
BUILDING ADDRESS -,271 a,?75-,27P ?1 a28? -?P4
STREET
SUBDIVISION:
NORTH ARROW
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CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPERVISOR (PRINT)
ED
STREEEETT ADDRESS / SIG ATURE
DATE
TOWN STATE ZIP INSPECTED BY TOWN
DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER