HomeMy WebLinkAboutDrain Layers Permits 300 Pepin Place 1900068 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 06/13/2019
GIS ID:70700300 FEE: 80.00
MUNIS APPLICATION# 201901241 a,�W s EXPIRATION DATE: 07/13/2019
APPLICANT `4' ' :`' ; r4 LOCATION
NAME: ATLANTIC EXCAV.QiIM,INC ADDRESS 300 PE IN PLACE
ADDRESS: 363 PARUM ROAD ' `s {i' s� F` �7N>R s y' & $UILDING CO.,INC.
y 0 BROOK STREET
COLCHESTER, CT64I< f� E
c i r y
PHONE 4
WORK DESCRIPTION: NEW SLrWF*
THE DRAIN LAYER ASSIGNED TO THISrI?E ]�uIIT HAS As.. :-, LICENSE ISSi�$1 f BY TH STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FOR i�N THE ATTAHED`GQI+IDI IpI�I ; AIZibRK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDARDS ALL OSHA:rtELiJTREMENfiS,A. TT) ATTACHED CONDITIONS.
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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: 3cc, Yo f/ Lot # Z
Street No. Street Name
Premises owned by:
Name of Phone:
Address of Firm: ,5� .... �. -�.� 4/,"s`7�� �
TYPE OF WORK:
Lay House Drain Repair House Drain ; Sanitary Disconnect
Lay Lateral for building with connection Z--''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 Date 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 ��, Z P the holder of Drain
Layer's License No. �'a!j!fE 1—e,2 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. 2CZ�;' PLEASE NOTE:
IF A SANITARY SEWER LATERAL
IS WITHIN 75 FEET OF A WELL
IT MUST BE AIR TESTED
Signe : Print Name:.,W � '
Licensed Drain L r
Date:
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT REVISION 3/2018.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS -SX 3o�
• T&,,
STREET .
SUBDIVISION: �
NORTH ARROW
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CONTRACTOR (PRINT) NAME OF CONTFkTID KSUPERVISOR (PRINT)
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STRE ADDRES SIGNAT RE /;
L1191 DATE
TOWN ff STATE ZIP INSPECTED BY TOWN
4S�l� ` 1i3- Is q a b DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER