HomeMy WebLinkAboutDrain Layers Permits 8 Schoolhouse Drive 1900088 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 07/31/2019 GIS ID: 81200008 FEE: 80.00
MUNIS APPLICATION# 201901619 F ��' IV y EXPIRATION DATE: 08/30/2019
APPLICANT ,'t� =t LOCATION
NAME: EAGLE EARTH USE DRIVE
ADDRESS: 101 N MOUNTAIN Rb5AI +# , OWNED 1ANNIRINO BUILDERS INC
*. i �'� f , 40 GH�PEL ROAD UNIT 3-F
CANTON,CT 06019 „r
PHONE 860 6 93p027
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WORK DESCRIPTION: NEW SliWft aONNE�T�OTtT'
THE DRAIN LAYER ASSIGNED TO THIS��?EI;i,�MITAS A Va ;ID'LICENSE ISS[JISTATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET POR1'H IN THE. TTACHED`CQNDITIQI�IS' tI L°WORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDAjDS,ALL DSIA 1ZE(�III2EMENT ,AI+iI IHE ATTACHED CONDITIONS.
ISSUED BY DATE INSPECTED INSPECT BY
7/31/2019 9;00 AM
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1p". OF SOUTH WINOSOR REPORT '
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LOCATION:
TYPE OF WORK: M.Low <S'
DATE INSP NEEDED; DATE INSP.. //t
INSPECTED-OY _
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INPUT: DATE. .
S/moltoyibms 2014 Town of South Windsor IMPS&ON REROW 14
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: Lot #
Street No. Street Name
ILIPremises owned by: ,-rf-�v sws
Name of Firm: Phone:
Address of Firm: Avr �� , - (U ®l
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
f� f
Connection will be made with
. 6 P
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 tuf clvl the holder of Drain
Layer's License No. - 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:
Licensed Drain Layer
Standard Forms\Permfts\APPLICATION FOR DRAIN LAYERS PERMIT REVISION 3/2018.doc
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TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION:
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STREET ADDRESS SIG ATURE
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TOWN �} STATE ZIP INSPECTED BY TOWN
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TELEPHONE NUMBER
WHITE - TOWN PINK CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
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CONTRACTOR (PRINT) NAME OF CONTRACTOR'S RVISOR (PRINT)
STREET ADDRESS SIGNATURE
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TOWN STATE ZIP INSPECTED BY TOWN
DATE 1
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER