HomeMy WebLinkAboutDrain Layers Permits 63 Clinton Drive (2) 1900073 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 06/14/2019
GIS ID:21300063 FEE: 80.00
4GIUNIS APPLICATION# 201901254 EXPIRATION DATE: 07/I4/2019
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APPLICANT
' LOCATION
NAME: ADB CONSTRUCTI N&.SFPTTC CORD ADDRh$S ¢3`i✓LI ITON DRIVE
ADDRESS: 77 A WOODLANDET '` OWiER BUDAIZ ISABELLE S ESTATE OF
'x 13 SKI DRIVE
MANCHESTER, CT406042
PHONE
860 66 -d579 : s
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WORK DESCRIPTION: NEW SIWIRyGO+JXVECTION
THE DRAIN LAYER ASSIGNED TO THIS PEI IVIIT 1Ih1S A VALiltuTZ.ID LI$W'04NW F ISSUED$I'T STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORTH°IN%THEiTTACHED; QNDITIONB' ALL l�l'ORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDAkDS,ALL OSIJA'RECUIREMENT S,AhTp THE ATTACHED CONDITIONS.
ISSUED B DATE INSPECTED INSPECTED BY
6114/2019 8:32 AM
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TOWN OF SQUT I:WINDSORINSPECUON REPORT
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PERMIT NO.: -1 CQNTRACTORco
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LOCATION:
TYPE OF WORK:
DATE INSP NEEDED: DATE INSP:.
INSPECTED BY: !
• . WORK:IN - . •• .. . . - -
PROGRESS: Cc.,•. �� - • d ,c� r. �,�<� a.�r., �' .�=''�"'�" •• •
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SEPTIC TANK PUMPED,SMASHED, FILLED .�!WITNESSED NO
AS-BUILT:
INPUT: DATE: -_w
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S/mollayFoorms ZOM Town Of South Wlndsar•MpS' E MbN REPORT 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: /' 'V Lot #
Street No. Street Name
Premises owned by:--.('
Name of Firm: Phone: a
Address of Firm: '72,? 6-.11`1,-rr(1.g-:,-„1 h /--L
TYPE OF WORK:
Lay House Drain_)c= 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
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Connection will be made with 7il C
Existing Water Supply: Public Water Well
Proposed Start Date A A� Estimated time for completion 71
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. Only holders of P-I, 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. ,;Y-{I i -Q.3o S-5 `73 PLEASE NOTE:
IF A SANITARY SEWER LATERAL
IS WITHIN 75 FEET OF A WELL
IT MUST BE-AIR TESTED
Signed: - Print Name: Ag t �
Licensed Drain Layer
Date:
Standard Forms\Permits\APPLICAIION FOR DRAIN LAYERS PERMIT-REVISION 3/2018.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS
STREET
SUBDIVISION:
a� y 14 c, A t.
NORTH ARROW 1 i E� Glk
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CONTRACTOR (PRINT) AME OF CONTRACTOR'S SUPERVISOR (PRINT)
F� W UOi I C�rtY
STREET ADDRESS SIG ATURE
DATE
TOWN STATE ZIP INSPECTED BY TOWN
�?wd 599 DATE
TELEPHONE NUMBER
WHITE - TOWN PINK -- CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER