HomeMy WebLinkAboutDrain Layers Permits 69 Shepard Way 1900083 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 07/11/2019
GIS ID: 82600069 E . FEE: 0.00
MUNIS APPLICATION# 201901412 h) s` EXPIRATION DATE: 08/10/2019
APPLICANT
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LOCATION
NAME: ATLANTIC EXCA �i3 4HE?ARD WAY
ADDRESS: 363 PARUM ROAD a� s
x ' dNEl 8�M I�UILDING CO.,INC.
RdOK STREET
COLCHESTER,CT Q6,4r15 . :;.
PHONE w ,
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WORK DESCRIPTION: NEW SWEP CONNCTIdN'PERMIT $I;": CJLLEGII;D'OV 201901411
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THE DRAIN LAYER ASSIGNED TO THIS"PEIL11�1IT HAS A t✓AT�ID L1ENSE ISSiIED�Y �H `STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FOR`I II I1 THEJ.TTACM-13`QQNDITIOI S' r I,T�WORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDA DST ALL OSI.A REQUIREMEN I'Sa ID TI' ATTACHED CONDITIONS.
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ISSUED BY J DATE INS EC ED INSPECTED BY
7/11/2019 12:07 PM
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TOWN OF SOUTH IARNDSOR M REPORT
PERMIT NO.: - CONTRACTOR:
LOCATION: .4 9, : S �
TYPE OF WQKK:
DINE INSP NEEDED: DATE INSP: �Z.
INSPECTED'BY:
PROGRESS:
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SEPTIC TANK PUMPE[,,.SMASHED; FlLLED WrMESSED []-YES NO,
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INPUT: C DATE,@-
S/mcltoy/totrns 200 Td=Of South Windsor•1NPSk[fON IREPOW 14
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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: �'� � C Lot #
Street No. Street Name
Premises owned by:
Name of Firm:_ e- �-"— u'� " c� Phone:
Address of Firm:_. .-�, � � ���- ��'0 C
TYPE OF WORK: �
x Lay House Drain ti 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 _,,�: e�
Existing Water Supply: Public Water �� Well
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Proposed Start Date %�" /� Estimated time for completion I� ;)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 � � �ti �Z �the holder of Drain
Layer's License No. <:�2ogry l 7 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. 2Lzz2 x�— ow PLEASE NOTE
IF A SANITARY SEWER LATERAL
IS WITHIN 7S FEET OF A WELL
IT MUST BE AIR TESTED
Signe . Print Name:
Licensed Drai yer
Date: s
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT REVISION 3/2016.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: -_C-L obll _
BUILDING ADDRESS " 44
STREET
SUBDIVISION: �` r
NORTH ARROW
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CONTRACTO RINT) NAME F CO PERVISOR (PRINT)
STR ADDRE S SIGNATURE
)2ATE
TOWN STATE zily INSPECTED BY TOWN
DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER