HomeMy WebLinkAboutDrain Layers Permits 67 Glenwood Road 1900063 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE; 06/03/2019 '
GIS ID: 35700067 FEE:' 80.00
MUNIS APPLICATION# 201901084 EXPIRATION DATE; 07/03/20I9
APPLICA LOCATION
NAME: WASTEWATER SER#I1QES��BA SKIPS ADDRESS 6 GLENWOOD ROAD
ADDRESS: 21 COURTNEY DRIV. ( R n Tl MRK1Y NICICLOS&LORISSA
67 GLE�!dWOOD ROAD
ELLINGTON, CT OC,br9tiZN
PHONE
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THE DRAIN LAYER ASSIGNED TO THISSPER11wIPI`HAS A�/ALID l�Ir✓E1+I5E:ISST,IT3 B SHE STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORTIS ffq THE k' TTACT3ED` ]�1DI IONS` :4ALL WORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDAI S AI L OSIIq'RE CJ'REME TTS,ANO TOTE ATTACHED CONDITIONS.
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S/mattoy/forms 7A14 Town of South Windsor•lNpSttT0N 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: �� w C ' Lot #
Street No. Street Name
Premises owned by: c 4- A?-k
Name of Firm: S 6�rPS �' �-''� '� Phone: S7s- 2 33 2
Address of Firm: �'� � Ey (01r- � �/U
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
Connection will be made with TV C- S)2 3 4r--
Existing Water Supply: Public Water Well
Proposed Start Date 4—u(J f- Estimated time for completion
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 `� �� �— X— the holder of Drain
Layer's License No. e)7 0 '7 7�5 Only holders of P-1,�Z 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. Z 2 3 2 -. PLEASE NOTE:
IF A SANITARY SEWER LATERAL
IS WITHIN 75 FEET OF A WELL
IT MUST BE AIR TESTED
Si ned. L Print Name: /V �AZ�� �
9
Licensed Drain Layer
Date: S'jo - /9
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT REVISION 3/2018.doc
Drabek, Bernard
From: callcenter@cbyd.com
Sent: Thursday, May 30, 2019 11:11 AM
To: C BYD
Subject: Locate Request - 20192203292
Attachments: 20192203292.PDF
(CALL BEFORE YOU DIG -CT) 05/30/2019 11:09:23
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1-SW SWINDS
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*** REMOTE BATCH ENTRY ***
***** ROUTINE*****
TI M E..11:09 DATE..05/30/2019
REQUEST NO...20192203292
LATITUDE..41.825639 LONG ITUDE..-72.521865
TOWN......SOUTH WINDSOR
ADDRESS...67
STREET....GLENWOOD ROAD
NEAREST
CROSS STREET..HIGH RIDGE DR
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TYPE OF WORK.....SEWER SVC INSTALL MACHINE EXC
I
AREA IS MARKED...YES
REMARKS:
CONNECTING HOUSE TO PUBLIC SEWERS. WORKING FROM BACK OF THE HOUSE TO FRONT.
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START DATE......06/04/2019 START TIME..00:01
CALLER..........MR GRADY OLIVER
CALL BACK.......
PHONE#.........860-896-8191
FAX#...........860-871-1587
ALT. PHONE#....860-871-2616
EMAIL ADDRESS...INFO@SKIPSWASTEWATER.COM
CONTRACTOR......SKIPS WASTEWATER SERVICES
ADDRESS.........21 COURTNEY DRIVE
CITY............ELLINGTON
1
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 SIGNATURE
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TOWN
/ STATE ZIP INSPECTED BY TOWN
DATE
TELEPHONE NUMBER
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