HomeMy WebLinkAboutDrain Layers Permits 274 Pepin Place 1900090 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 08/08/2019 U � w k ;
GIS ID: 70700270
MUNIS APPLICATION# 2019017080 r �* `' ,r FEE: 80A0
EXPIRATION DATE: 09/07/2019
APPLICANT `, � f � � '` LOCATION
NAME: ATLANTIC EXCAV ;I 1lG� p DREr: 95,PEPIN PLACE/#3 KENNISON CT
ADDRESS: 363 PARUM ROAD QT '.: &M ILDING CO.,INC.
' r� °:�� �� � � �';� »: I � ' K STREET
COLCHESTER CT y �
PHONE � All
WORK DESCRIPTION: BUILD Cr10Sf}R t.y I OURT,270,274,
THE DRAIN LAYER ASSIGNED TO THIElY.TFAS STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FOABKit—
M iETi C �� RK SHALL BE IN ACCORDANCE WITHH
THE TOWN OF SOUTH WINDSOR STAND ;d L OI A 1I 1 5,AXQ T E ATTACHED CONDITIONS.
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ISSUED 33f DATE INSPECTED INSPECTED BY
8/8/2019 2:43 PM
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TO�IP SQU1`N�YVEMMORI�NSPEC�N REPORT
PERMIT ND.: z2aCQIVTRACT�R:_��.�C
LOCATION:
TYPE OF WORK: S�
DALE INSP:_ Z �r
DATE INSP NEEDED:�- I
INSPECrED-BY: 9L
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SEPTIC TANK PUMPED,.SMASHED;FIL'LPD
1lVITiVESSED ❑-YES Q NO
AS-BUILT:
INP UT 'V DATE:
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IGH Tan of South Windsor•INPS�IION E
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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 $$OAU
Location of proposed work? ���' .ta8 s°.� „�>d �y ►� Lot# '�, �a
Street No. Street Name
Premises owned by: , c: _
Name of Firm: Ph
one: 3 �
Address of Firm:__ �'.� ,•�v,.1 cr C7�
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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
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Connection will be made with
Existing Water Supply: Public Water r/ UUe(1
Proposed Start Date <315;' S Estimated time for completion ";2,45ZL
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ALL WORK TO BE IN ACCORDANCE WITH TOWN OF SOUTH WINDSOR STANDARDS,
ALL OSHA REQUIREMENTS AND CONDITIONS ATTACH® TO THE PERMIT
Permit is to.be.issued to
the holder of Drain
Layer's License No. 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. Q o Z L1,3 PLEASE NOTE:
IF A SANITARY SEWER LATERAL
IS WITHIN 75 FEET OF A WELL
IT MUST BE-AIR TESTED .
i
Signe : Print Name:
Licensed Drain er
Date: t
Standard FormsNPermits\APPUCATION FOR DRAIN LAYERS PERMIT REVISION 3/2018.doc
TOWN OF SOUTH WINDSOR .
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS 2�Z � � ezlq Z7 o - -3
STREET
SUBDIVISION: t —�
NORTH ARROW �f
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CONTRACTOR PRINT} NAME F C SUPERVISOR (PRINT)
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STREET ADDRESS SIGNATURE
ti � ✓ DATE
TOWN STATE Z1P INSPECTED BY TOWN
I DATE
TELEPHONE NUMBER
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WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER