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HomeMy WebLinkAboutDrain Layers Permits 19 Oakland Road 1900080 TOWN OF SOUTH WINDSOR, CT PERMIT NUMBER DRAIN LAYER PERMIT I" ! k DATE: 06/27/2019 GIS ID: 65700019 FEE: 80.00 MUNIS APPLICATION# 201901367 EXPIRATION DATE: 07/27/2019 APPLICANTLOCATION NAME: WILCOX EXCAVATG,�dNS�RUCTIQN ADDRESS 19 bALAND ROAD ADDRESS: 71 WILLOW STREET . ,, `! QWNERG HQME CARE LLC FARM RD SOUTH WINDSO1QCTPii06Q7 F PHONE WORK DESCRIPTION: DISCO NEy x`S"$ THE BUILDING YS BEIN pEMdRD THE DRAIN LAYER ASSIGNED TO THIS PE +IITHiS A VAI,IbsI,IC>;1SE I$SU E AND HEREBY AGREES TO ALL THE TERMS AND CONDITIONS SET FORTH`II�T SHE ATTAzrHEI `CDIT�ON1sy ALL CORK SHALL BE IN ACCORDANCE WITH THE TOWN OF SOUTH WINbSOR STANDATtI1S,ALL USHA;REQUIREIIIkIT ,AND TT ATTACHED CONDITIONS. k. dolk C4 �1J ISSU BY DATE INSPECTED INSPECTED BY 6/27/2019 11:24 AM n+ Nil- zo 4. � x i N N fizz Ali � s 4 a � T 3tixy � 4 4 Y SS k 1 1 f 5, x: u TOWJM OP SOUTH:WWWORIMSPEC1iON REPORT PERMIT NO.: I . COWRACTOR: LOCATION: © LlaLd &a d. TYPE OF WORK: S DATEINSP; .( 7 DATE INSP NEEQED INSPE{:TE ,W-- A.2> . . W09KIN PROGRESS: - ��.1 • :ems �- .. ..- � - - : SEPTIC TANK PUMPED,.5MAS 1M. FILLED W NESSED ❑-YES CI NO' ' AS-BUILT: INPUT: DATE: S/moi[l2yi%ms 2M4 Town of South Winadr-imPS&N REPORT i4 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 a A V larva 0Gt j Lot # Street No. Street Name Premises owned by: - +`q+V z i15SO6 Name of Firm: + - ' Phone: Address of Firm: L41,lL " _ : G , , ,t r cJCc97 TYPE OF WORK: / Lay House Drain ; Repair House Drain ; Sanitary Disconnect l� 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 Existing Water Supply: Public Water Well Proposed Start Dated 1 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 rld Wr�r O K the holder of Drain Layer's License No. PLM, 0•Z c - 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. t �S C� PLEASE NOTE: IF A SANITARY SEWER LATERAL IS WITHIN 75 FEET OF A WELL IT MUST BE-AIR TESTED , Sign J Print Name: Gt rAd G(.'o D Licensed drain Layer . Date: Standard Forms�Permits\APPUCA ON FOR DRAIN LAYERS PERMIT REVISION 3/2618.doc TOWN OF SOUTH WINDSOR SANITARY SEWER LATERAL FIELD LOCATION DATE OF CONSTRUCTION: _i `Z27 BUILDING ADDRESS ,Z-19:- `� J STREET : ice 6 ! 1 SUBDIVISION: NORTH ARROW { (� 1 .___LVT If �T__ r T \t CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPERVISOR (PRINT) STREET ADDRESS 1 UR M ' j ,d DATE TOWN STATE ZIP INSPECTED BY TOWN DATE TELEPHONE NUMBER WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER