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HomeMy WebLinkAboutDrain Layers Permits 6 Longmeadow Drive 1900078 TOWN OF SOUTH WINDSOR, CT PERMIT NUMBER DRAIN LAYER PERMIT DATE: 06/20/2019 GIS ID: 54670006 k' FEE: 80.00 MUNIS APPLICATION# 201901299 EXPIRATION DATE: 07/20/2019 APPLICAN* ' LOCATION NAME: SSC CONSTRUCTIO- L C. ADDRE 6 L t7NOMEADOW DRIVE ADDRESS: 1700 SAYBROOK R7' T OWNE�2, TOI,LAND XVIII LIMITED PARTNERSHIP 42 OLI7 UDGEBURY ROAD MIDDLETOWN, C'90,6457�^ PHONE WORK DESCRIPTION: NEW S&-.) CONNECTION` x e :i THE DRAIN LAYER ASSIGNED TO THI51�PE1kVIIT HAS A VAT:ID I,IC1i�NSE ISSUED$Y1HI;''STA.41 TE AND HEREBY AGREES TO ALL THE TERMS AND CONDITIONS SET FORTH°FN3E;A*TTACFIEI3 C"{JItIDITIQNS' A�I ARK SHALL BE IN ACCORDANCE WITH THE TOWN OF SOUTH WINDSOR STANDAS,ALA OSHA REQi7IREMENT S,AID TEE ATTACHED CONDITIONS. 0 'llJo r � ISSUED BY DATE INSPECTED INSPECTED BY _ 6/20/2019 3:25 PM r' S R s r ��1 I� i• { 4yA isy tv Y ' y4 A �3 � sky ,•; � ,, � i �.: i �. 1 4`� r .4 Z•1 sr,v, 1 y, �{ T ,�rx 1 ,};.f 5 YI { S r'k y .ISSN t t dry' IIj T t r r L TWA OP SQUTN: ilmooR 3ifliN REPART PERMIT NO.: • WNTRACTOR: LOCARON: 69 A , TYPE OF RK: ©ATE INSP NEEDED: •. = • : � . . DATE INSP::. INSPECTED BY: WORK-.IN PROGRE,�S: '�, �i �' '.._,wizA Cs� t'7"T �cYt4 �rr✓.r� wi'. Y�G+ SEPTIC TANK PUMPED; HED; #.LED WITNESSED ❑•YES 0 NO AS-BUILT ' - DATE: - INPtT: ..... - REPORT'14 S/miltoy/f rm 2014 Town of South Windsor I PSECRON 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: 6 tom►ti-C�10,w ;-) VL Lot # L�s Street No. Street Name Premises owned by: �_0 0` O MS• IYI C-- Name of Firm: SSc &o 51 ru e k Phone: �Ga. zja. 2� Address of Firm: 7aca J;;4roo k 22 n-z + 16ve"n C 7 C16tif 7 TYPE OF WORK: ,r Lay House Drain 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 6 S� Existing Water Supply: Public Water Well Proposed Start Date �`l 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 s��� ��� '� the holder of Drain Layer's License No., Psi Dz F-7 Ni/ P7 . Only holders of P-1, F-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. K-3 I PLEASE NOTE: IF A SANITARY SEWER LATERAL IS WITHIN 75 FEET OF A WELL IT MUST BE AIR TESTED . Signed: Print Name: S�t� �-••N k o Licensed Drain Layer Date: . 2 v - 1 . I . ..... Standard Fcrms\Permb\APPLICATION FOR DRAIN LAYERS PERMIT REVISION 3/2018.doc TOWN OF SOUTH WINDSOR SANITARY SEWER LATERAL FIELD LOCATION DATE OF CONSTRUCTION: L' BUILDING ADDRESS STREET � SUBDIVISION: NORTH AR W 4W � ! LIP- 677 F I f-` f A ���C.L.��.-,1�.._.- --r-..�,�...-..__`f.___J___-_mac t__._. � ._.-_.J.�.____.1_.-._x._..._..t.-..�,I•�_r-_.._ J�_..__.�^c��., ._.x...� CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPERVISOR (PRINT) STREET ADDRESS SIGNATURE �✓I C)Jet ?dw _� __ C C�� ,�' / / DATE TOWN STATE ZIP INSPECTED BY TOWN ���'✓ 5r1 - 1 DATE TELEPHONE NUMBER WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER I