HomeMy WebLinkAboutDrain Layers Permits 308 Pepin Place 1900074 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 06/14/2019
GIS ID: 70700308 FEE: 80.00
MUNIS APPLICATION# 201901256 ' > EXPIRATION DATE: 07/14/2019
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APPLICANfi
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NAME: ATLANTIC EXCAV1,'TIQNINC t4DDRESS 308 PI;pIN PLACE
ADDRESS: 363 PARUM ROAD s1 Y F OWNiit ,' T&r BUILDING CO.,INC.
xCIyBRQOK STREET
COLCHESTER,CT 464 i5
PHONE
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WORK DESCRIPTION: NEW SAWIaI iCTTiDI�'PERMIT FEE QLL CTED Q,fiT
APPLICiN 2Q19Q1241 n,
THE DRAIN LAYER ASSIGNED TO THI SfEN; IIT',HAS A,VALID Lex"A E ISSUI IJ BY THE STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FOR ,H IN THE ATTACHED`GC)NDITIlJIr1S' L WORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDAS ALL I7TItEMEN1" ,AND TIDE ATTACHED CONDITIONS.
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ISSUED BY DATE INSPECTED INSPECTED BY
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TOWS OF SOUTH WINDSOR,INSPEcuaiM REPO"
PERMIT NO.. CONTRACTOR.
LOCATION:
TYPE OF WORK:
DATE INSP NEEDED: DALE INSP:-
INSPECTED'
WORK:IN
PROGRESS: �z• - ,� � `�' c✓� �b r?- �� '
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SEPTIC TANK PUMPED,.SMASHED; FILLED � WrMESSED ❑-YES CJ N0
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INPUT: DATE:-
5/mallayjWrms ZQi4 Towo of South Windsor.MPS�N R�PO> i4
APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SUH IVAN AVENUE
SOUTH WINDSOR, CT
FEE $80.00
Location of proposed work: a. 3a ✓ "3 �i ��
Street No. Street Name
Premises owned by: �—
Name of Firm: Phone:
Address of Firm: Q� ?���
TYPE OF WORK:
Lay House Drain ;Repair House Drain ; Sanitary Disconnect
Lay Lateral for building with connection Z--1--or no connection ;
Lay Main
Lay Lateral for Commercial/Industrial Building number of acres
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Connection will be made with
Existing Water Supply: Public Water Well
Proposed Start Dater t Estimated time for completion i
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 4 l the holder of Drain
Layer's License No. f—P4 . Only holders of P-1, P-7 or W-9 licenses
will be issued a permit. PERMIT WILL EXPIRE THIRTY (30) DAYS AFTER i
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
Signe ; Print Name:
Licensed Drain L r
Date:
Standard Farms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT REVISION 3/2016.doc
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TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: 61 611
BUILDING ADDRESSal
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SUBDIVISION:
NORTH ARROW
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CONTRACTOR (PRINT) NAME OF CONTF4rT0fttk SUPERVISOR (PRINT) j
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STRE DDRES SIGNAT RE
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TOWN STATE ZIP INSPECTED BY TOWN
DATE t
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER