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HomeMy WebLinkAboutDrain Layers Permits 270 Pepin Place 1900090 TOWN OF SOUTH WINDSOR, CT PERMIT NUMBER DRAIN LAYER PERMIT DATE: 08/08/2019 = � k GIS ID:70700270 ~ s K "a_, FEE: 80.00 MUNIS APPLICATION# 20I901708 ,, EXPIRATION DATE: 09/07/2019 } j :h% APPLICA f y Tf f LOCATION NAME: ATLANTIC EXCAVA $I� DRE�:: 7C1�29 PEPIN PLACE/#3 KENNISON CT 12. ADDRESS: 363 PARUM ROAD 4 r 3 8& UILDING CO.,INC. v. KSTREET COLCHESTER,CT rti 5 ; PHONE um WORK DESCRIPTION: BUILD €7kI :� OURT,270,274, 278,282, p � THE DRAIN LAYER ASSIGNED TO THI E HAS I,SSSTATE AND HEREBY AGREES TO ALL THE TERMS AND CONDITIONS SET FOR �' FT: 4` �I� C+,1 rL RK SHALL BE IN ACCORDANCE WITH THE TOWN OF SOUTH WINDSOR STAND �I OS�� 4 �S, T, ATTACHED CONDITIONS. ` jr I tp 8/8/2019 2:43 PM UED ISS B.S. DATE INSPECTED INSPECTED BY I • I - E f F f r ' t E� . 1 ' F t ' l • E 1 To"©F SQUMMINDSOR.IMSPWOP Rem! PERMIT NA.: ' 000� WNTRAO-10R,_ � LOCATION; TYPE OF WOOK: DATE INSP NEE..ED: DATE INSP;. f z jr INSPECTED' W0RKIN VL . na- v v SEPTIC TANK PUMPEQ,SMASHED; FILLED . .. . . . WrMESSED ❑-YES Q NO' AS-BUILT: INPUT;_.1 DATER-'-* ATE: -- S/mollay/trms 2014 Town of Snath Windsor INPS=14 REPORT 14 f i - h 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�-?� -?;�y ,77 r a?W" Street No. Street Name t Premises owned by: /� << c: _ I Name of Firm: /� 2 Phone: 5C"d Address of Firm: %�-- TYPE OF WORK: Lay House Drain R ppair House Drain ; Sanitary Disconnect Lay Lateral for buildingwith connection____;^..._; or no connection ! Lay Main ! Lay Lateral for Commercial/Industrial Building number of acres Connection will be made with _S221C_ 13- f i Existing Water Supply: Public Water Well Proposed Start Date B 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 �� ,� _fix 4. 7�� � the holder of Drain Layer's License No. (3e-?--5T y-r? 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 I and conditions set.forth in the permit and attached thereto. Applicant has received I Town Street Excavation Permit No. and/or ConnDOT Permit No. f f CBYD No. PLEASE NOTE: IF A SANITARY SEWER LATERAL IS WITHIN 75 FEET OF A WELL IT MUST BE-AIR TESTED Signe : Print Name:_��� �� ,�� Licensed Drain er Date: t Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT REVISION 3/2018,doc f I I TOWN OF SOUTH WINDSOR SANITARY SEWER LATERAL FIELD LOCATION DATE OF CONSTRUCTION: BUILDING ADDRESS : 'Z2 2*1W '27q Z-10 -"-3 STREET SUBDIVISION: NORTH ARROW . 26ZI I . I i ` ( E I1 ..I AAA 1 F \ �L- FIR -rX) kit CONTRACTOR PRINT) NAME F C ISUPERVISOR (PRINT) STREET ADDRESS SIGNATURE '! DATE TOWN STATE ZIP INSPECTED BY TOWN DATE TELEPHONE NUMBER i t WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER