HomeMy WebLinkAboutDrain Layers Permits 283 Pepin Place 1900049 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 05/08/2019
GIS ID: 70700283 x
FEE: 0.00
MUNIS APPLICATION# 201900887 ti' •{ EXPIRATION DATE: 06/07/2019
APPLICANT LOCATION
NAME: ATLANTIC EXCAVATIC?N 1NC ADDRESS $3 PE� IN PLACE
ADDRESS: 363 PARUM ROAD;; ! p1R Iw x BUILDING CO.,INC.
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"w y '110 BROOK STREET
COLCHESTER,CT, 4415
PHONE
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WORK DESCRIPTION: NEW S%4WE� O,NN�CTTON BUILDING 14 S(J 1 3 WTN17$OR WOODS
PERMIrRv*9 C( L LECTRD ONA c,,,. I N 4151,
01,900$�4>k
THE DRAIN LAYER ASSIGNED TO THIS REMIT HAS AV,
LIrrE1ISEFISSiN
U$D BY T'HSTATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FOI&i'�N THE ATTACHED`CONDITIONS' IrL V ORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDADS,ALL OS11lp"ZEQUIIYEMEI�IT S�AND�3 ATTACHED CONDITIONS.
I5 D It DATE INSPECTED INSPECTED BY
5/8/2019 11:17 AM
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'I W DF SQUTH•.WINDSORINS ECITON REPORT .
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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: �/�' :',�?9„� RIr7•?A/ �et-#
Street No. Street Name •��r ��
Premises owned by: 7 Bo,'
Name of Firm:_ ����.e.T�c �, 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 withc�-
Existing Water Supply: Public Water Well
Proposed Start Date 35 7 Estimated time for completion — 5
ALL WORK TO BE IN ACCORDANCE WITH TOWN OF SOUTH WINDSOR STANDARDS,
ALL OSHA REQUIREMENTS AND CONQ IO ATTACHED TO THE PERMIT
A5 � .
Permit is to be issued to 4 the holder of Drain
Layer's License No.cyc T�frsy 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. PLEASE NOTE:
IF A SANITARY SEWER LATERAL
IS WITHIN 75 FEET OF A WELL
IT MUST BE AIR TESTED
Sign d: Print Name:
Licensed Drain yer
Date:
Tom'^
Standard Forms\Permits\APPLICAMN FOR DRAIN LAYERS PERMIT REVISION 3/2018.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS ' /�
STREET
SUBDIVISION:
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CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPERVISOR (PRINT)
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STREET ADDRESS / SIG ATURE
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TOWN STATE ZIP INSPECTED BY TOWN
DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER