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HomeMy WebLinkAboutDrain Layers Permits 312 Pepin Place 1900075 TOWN OF SOUTH WINDSOR, CT PERMIT NUMBER DRAIN LAYER PERMIT DATE: 06/14/2019 gp GIS ID:70700312 r. ;.. FEE: 0.00 MUNIS APPLICATION# 201901257 a „s EXPIRATION DATE: 07/14/2019 z A � APPLICAII LOCATION NAME: ATLANTIC EXCAVATI NiIN W �1DDRE S 312 PE?IN PLACE ADDRESS: 363 PARUM ROAD a OTTER Tr 8c M BUILDING CO.,INC. $ROOK STREET COLCHESTER,CTb641rt5 r PHONE ` 4 A' WORK DESCRIPTION: NEW SEWER CO C 'I IN,PERMIT 'EE CQ1,r �1 ED ON APPLICtf`I�6N`2019j1241 t" THE DRAIN LAYER ASSIGNED TO THIS I'ER�IIT HQS A�A�ID LI�E1�T$Z ISSUI;1�BY THl�`STATE AND HEREBY AGREES TO ALL THE TERMS AND CONDITIONS SET FOR QNIII II�JS' ALLRK SHALL BE IN ACCORDANCE WITH THE TOWN OF SOUTH WINDSOR STANDARDS,ALA O$HA REQ JIT E16ENTS,A TIC ATTACHED CONDITIONS. � �o IIoC f ISSUED BY DATE INSPECTED INSPECTED BY 6/14/2019 9:19 AM F Ali u. k G R Ri S rRF 4 ySys y 4 F g s k: snryrtlfi 4 2 i tc r+ iC r`sYy.Fy F q r s TpW OF SQUTM.WINDSOR INSP EC'[Y4N REPORT PERMIT NO.: ® CONTRACTOR:- LOCAMON: TYPE OF WORK:_, DATE INSP NEEDED` DATE INSP: U. -2`"'f INSPECTED BY: WORK:IN s PROGRESS: c."�-m.- p `ems �►` '- C S'��r S© r i G 5MASHED FILLED WaNESSED ❑YES CI NO SEPTIC TANK PUMPS r. BUILT•• INPUT: DATE: iV ICI:PORT 14 of South Windsor MPSWW S/mol[oyjtvr�2�].4 Town . I 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 Street No. Street Name Premises owned by: r AZ Name of Firm: Phone: Address of Firm: �� �� ��5�` �� C7— 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 Connection will be made with Existing Water Supply: Public Water L-� Well Proposed Start Date �'r r 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_ a,v the holder of Drain Layer's License No. clFa Y-ff f l_:,'Z. 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. , c 2,9 PLEASE NOTE: IF A SANITARY SEWER LATERAL IS WITHIN 75 FEET OF A WELL IT MUST BE AIR TESTED Signec,' —Z Print Name: y Licensed Drain L r Date: Standard FormsWennitS\APPLICATION FOR DRAIN LAYERS PERMIT REVISION 3/2016.doc TOWN OF SOUTH WINDSOR SANITARY SEWER LATERAL FIELD LOCATION DATE OF CONSTRUCTION: 1�1 6 _.. BUILDING ADDRESS STREET qcicl S EET . SUBDIVISION: NORTH ARROW : F ' { I i llrz Aft -4 _ [ ! •__ - CONTRACTOR (PRINT) NAME OF CON T SU ERVISOR (PRINT) STRE ADDRESS Y SIG RE / c C. f DATE TOWN STATE ZIP INSPECTED BY TOWN DATE TELEPHONE NUMBER WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER DEVELOPER