HomeMy WebLinkAboutDrain Layers Permits 275 Pepin Place 1900047 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER
DRAIN LAYER PERMIT
DATE: 05/08/2019
GIS ID: 70700275 -• `
MUNIS APPLICATION# 201900885 t FEE: 0.00
r' w EXPIRATION DATE: 06/07/20I9
APPLICANT` t T r '
+ ° 1 c; . LOCATION
NAME: ATLANTIC EXCAV• TION ZIVC a
ADDRESS: 363 PARUM ROAD'},t fs; ADDRESS 27$'PE'IN PLACE
OWNER &1VI WILDING CO.,INC.
COLCHESTER, CT I16 BRC10K STREET
PHONE y
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WORK DESCRIPTION: NEW SEWER Ca1�IECTION BUILDING I1 PER pE zO
APPLICA�7 ON 201'9:OU,884 w ,5 LLEC TED ON
THE DRAIN LAYER ASSIGNED TO THIS`PEtMI F HAS A YAi ill LICNE ISSUEIJ$ STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORM"IN THE;ATTAHE1 `CONDITIONS' LTp SHAI L BE ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDARDS IN AIL OSHA RZ;t�ITIREM$NTS,AND T•;.FTE ATTACHED CONDITIONS.
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ISS ED DATE INSPECTED
5/8/2019 11:01 AM INSPECTED BY
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TOWJI OF SOIUM WINMRQ 114$0.9 ON REPORT
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S/moltoy/forms T 14
ZOR Town aF South Windsor MPSWMN i(EPOR
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: ,,771 Z�"73'-,M, --ell
Street No. Street Na-me r
Premises owned by: 75,25 '
Name of Firm: i��u'7 rc �� �n ^ �, Phone: 7C
Address of Firm:
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 c 5
ALL WORK TO BE IN ACCORDANCE WITH TOWN OF SOUTH WINDSOR STANDARDS,
ALL OSHA REQUIREMENTS AND CONPI��I ATTACHED TO THE PERMIT
Permit is to be issued to the holder of Drain
Layer's License No.(:V® RfzTY -- 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. �i�`�a�%' PLEASE NOTE:
IF A SANITARY SEWER LATERAL
IS WITHIN 75 FEET OF A WELL
IT MUST BE-AIR TESTED .
Sign d: Print Name: Cr :C�,rs l� ry
Licensed Drain yer
Date:
Standard Forms\Permits\APPLICA-RON FOR DRAIN LAYERS PERMIT REWSION 3/2016.doc
TOWN OF SOUTH WIN DSO R
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION:
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BUILDING ADDRESS
STREET
SUBDIVISION:
NORTH ARROW
10
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CONTRACTOR (PRINT) NAME OF CONTRACTORS SUPERVISOR (PRINT)
STREET ADDRESS / SIG ATURE DATE
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TOWN STATE ZIP INSPECTED BY TOWN
>c DATE
TELEPHONE NUMBER
WHITE -- TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER