HomeMy WebLinkAboutDrain Layers Permits 100 Scantic Meadow 1900065 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 06/12/2019
44
GIS ID: 81000100 FEE: 80.00
MUMS APPLICATION# 201901226 k 0"0EXPIRATION DATE: 07/12/2019
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APPLICAN`I' LOCATION
NAME: DAMES THROWE DBA �,, y' ADDRESS00 SC�ANTIC MEADOW ROAD
ADDRESS: 1330 MAIN STREETS"r rtil t OVTIIR KASIN11vR NANCY L
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SCANTIC MEADOW R
SOUTH WINDSORl w660,114 y
PHONE 860-289 0095
WORK DESCRIPTION: NEW SWROW�Y ,CTIf�N
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THE DRAIN LAYER ASSIGNED TO THISiPEI IT HAS A uf4L1D I.I IfIz LT.] *THR`STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORTH'°1`N I E.ATTAGIIED`COIkiDIT1QNS' 7 i L CORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDARp A ,L 05HA'REtUIREMENTSr AND THE ATTACHED CONDITIONS.
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IISSUED BY DATE INSPECTED INSPECTED BY
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TOWN OF SOUTH MR
'ECTION REPORT
PERMIT NO.: • a2V . CONTRACTOR.
LOCATION: i9i9•
TYPE OF WORK. C�►'� ht� �� .
DATE INSP MOW DATE iNSP: 11_�'`J
INSPECTED Ort
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S/malfo'yfforms=4Taws Of South Windsor•Mpsw IO
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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
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Location of proposed work:-1 '�'.� ,, .,1 `' (�_ ;�FE;r ..�' Lot #
Street No. Street Name
Premises owned by: \� •
Name of Firm: , a y- ,.,I,,L � �,�- Phone: (S�(? � i5'
Address of Firm:
TYPE OF WORK:
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 J�
Existing Water Supply: Public Water Well
Proposed Start Date N `� p J mti
p Estimated time for com letion L
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 �-LlO'y the holder of Drain
Layer's License No. Q c 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. PLEASE NOTE:
IF A SANITARY SEWER LATERAL
IS WITHIN 75 FEET OF A WELL
IT MUST BE-AIR TESTED .
Signed: Print Name: cz�mxJ
Licensed Drain Layer
Date:
Standard Forms\Permlts�,APPUCATION FOR DRAIN LAYERS PERMIT REVISION 3/2018.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: J-LI
BUILDING ADDRESS ' 4{
STREET : SLi N 71 C
SUBDIVISION:
NORTH ARROW
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CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPERVISOR (PRINT)
STREET ADDRESS SIGNA, E
�. <<•:,_ ._,. -�"- c'°">�r � � � I Z / DATE
TOWN STATE ZIP INSPECTED BY TOWN
DATE
TELEPHONE NUMBER
WHITE — TOWN PINK — CONTRACTOR YELLOW — CONSULTING ENGINEER / DEVELOPER