HomeMy WebLinkAboutDrain Layers Permits 665 Nevers Road 1900077 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER
DRAIN LAYER PERMIT
DATE: 06/20/2019
GIS ID: 62400665 c
MUNIS APPLICATION# 201901293 FEE: 80.00
H EXPIRATION DATE: 07/20/2019
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LOCATION
NAME: JACQUES CONSTRljtTIQN{JOHN) ADDRESS 665 VE ERS ROAD
ADDRESS: 67 RIDGE ROAD t OWNER
Fr j2R x I�OftSESHOE LANE ASSOCIATES LLC
*k 18 3 AR HUR DRIVE
SOUTH WINDSOR,, T 060 74 4 u�
PHONE 860-432 I$ 3 j
WORK DESCRIPTION: NEW Sef
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THE DRAIN LAYER ASSIGNED TO THI}S4PERIV,IIT FIRS A VAT�I1 IxTCLNSE ISSUED`BY TT�I STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORT I Tj l THE-ATTACHED'GQNDI'TIQ14S' AI;,L V4 bRK SHALL BE IN ACCORDANCE WITH
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T14E TOWN OF SOUTH WINDSOR STANDARDS,AL1.OSI�A 1ZEQfTIREMI{NTS,A1�DrTIirE ATTACHED CONDITIONS.
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ISSUED BY DATE INSPECTED INSPECTED BY
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TownOF SQUTH:ININDSQR INSPECTYON REPORT
PERMIT'NO.: . M6 Z7 CONTRACTOR: � - ,
LOCATION:
TYPE OF WOO.
DATE INSP NEEQED• DATE INSP. � r
INSPECTED
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INPUT: . DATE.
S/molloyArms 2014 Town Of SbUt t Wiftftr•INPSEiMbN REPORT'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: e S Lot #
Street No. Street Name
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Premises owned by:
Name of Firm: Phone: 30rQA0
Address of Firm: AV
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
Existing Water Supply: Public Water Well
Proposed Start Date 6:YL& 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 the holder of Drain
Layer's License No. Only holders of P-I,Y---,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: rint Name: �-
Licen d i ayes
Date:
Standard Forms\Permits\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: o Lao 17
BUILDING ADDRESS
STREET
SUBDIVISION:
NORTH ARROW
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CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPERVISOR (PRINT)
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STREET ADDRESS SIGNATURE
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TOWN STATE ZIP INSPECTED BY TOWN
D ' `I 3 r): �'2,3 _ DATE
TELEPHONE NUMBER
WHITE — TOWN PINK — CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER