HomeMy WebLinkAboutDrain Layers Permits 67 Shepard Way 1900082 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 07/11/2019 '
GIS ID: 82600067 x
MUNIS APPLICATION# 201901411 FEE: 80.00
w EXPIRATION DATE: 08/10/20 i 9
APPLICANT + ' "R LOCATION
NAME: ATLANTIC EXCAVATION INC x !� ADDRESS �7"SHARD WAY
ADDRESS: 363 PARUM ROAD d "' VNEK ;y T 8y M BUILDING CO. INC.
Rd K STREET
COLCHESTER, CTj6415 5 3
PHONE
WORK DESCRIPTION: NEW SEWEX GOIiNECT�OId DUPLEX#6 J 69 E N r
THE DRAIN LAYER ASSIGNED TO THIS~PEROKIT {HiS A V1LI�)aIC,ENSE ISSUED$Y�T1II'STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FOR"[H�TN`THE;4T"FACI ED`C NDIT� NS' ALL,WbRK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDAIDS,AI L 0SUx1'REC)[JIREMEN7 S,AI!dD TkE ATTACHED CONDITIONS.
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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'7-1Cz9 Lot #
Street No. - Street Name
Premises owned by:
���{Name of Firm: � ,� �s�� port .�-.c c� Phone:
Address of Firm:— 2 3 �,��, � ,�� /`C75
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 ell 52W,3-5-
Existing Water Supply: Public Water Z—� Well
Proposed Start Date Estimated time for completion a 1 s
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 c- the holder of Drain
Layer's License No. 4V0:yy k -,P 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. PLEASE NOTE
IF A SANITARY SEWER LATERAL
IS WITHIN 75 FEET OF A WELL I
IT MUST BE AIR TESTED
Signe Print Name:_
Licensed Dra yer
Date:
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT REVISION 3/2016.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS L4 31
STREET
SUBDIVISION:
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CONTRACTO RINT) NAME F CO UPERVISOR (PRINT) /
STREET ADDRE S SIGNATURE
6416 4�����
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TOWN STATE ZO INSPECTED BY TOWN
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TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER