HomeMy WebLinkAboutDrain Layers Permits 290 Pepin Place 1900090 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
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DATE: 08/08/2019
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GIS ID:70700270 ' �` FEE; 80,00
MUNIS APPLICATION# 201901708 7 �� �$ EXPIRATION DATE: 09/07/2019
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APPLIC ; ,�� �k LOCATION
NAME: ATLANTIC EXCAV G. .,. h DRE�:: 7 =29 PEPIN PLACE/#3 KENNISON CT
ADDRESS: 363 PARUM ROAD &M UILDING CO. INC.
Ya K STREET
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COLCHESTER,CT � ¢'
PHONE 3
WORK DESCRIPTION: BUILD k Z fiT(COURT,270,274,
278,282, Pa '
THE DRAIN LAYER ASSIGNED TO THIPE I _�AS ApE -IS SL�1l•�STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FOR�H, FHL 1 TAC� T�4 S��„ Ir VbRK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STAND A�D ; I OAII115,A3YA TkfE ATTACHED CONDITIONS.
ISSUED DATE INSPECTED INSPECTED BY
8/8/2019 2.43 PM
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PERMIT NO,.
LOCATION:
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�' DATE: �
S/mol4oy�fnrrc�s 2014 To=or Snug Wi t&or•IMPSE£i N IMPORT 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: ?t' W7 2r e n? ..>a -'rk RLot
Street No. Street Name
Premises owned by: ��'yt
Name of Firm: �,��iz r �� � "7;�� Phone: 5C''0
Address of Firm:
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 s5/9_ /? 3 7 2,
Existing Water Supply: Public Water c/ Well
Proposed Start Date i S" 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 �i ��,c � 4 �, the holder of Drain
Layer's License No. 783'-ram 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. /)'/3 PLEASE NOTE:
IF A SANITARY SEWER LATERAL
IS WITHIN 75 FEET OF A WELL
IT MUST BE.AIR TESTED .
Signe : Print Name:� �
Licensed DrainLalrer
Date: 0 y Z'
standard Forms\Perm ts\APPLICATION FOR DRAIN LAYERS PERMrr REVISION 3/2018.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS �� �
STREET
SUBDIVISION: l
NORTH ARROW
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CONTRACTOR PRINT) NAM IC
SUPERVISOR (PRINT:)
STREET ADDRESS SIGNATURE
hi> .✓ ,;-'� - � �, DATE
TOWN STATE ZIP INSPECTED BY TOWN
%66 5/ DATE:31- -Wit
TELEPHONE.NUMBER
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