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HomeMy WebLinkAboutDrain Layers Permits 278 Pepin Place 1.900090 TOWN OF SOUTH WINDSOR, CT PERMIT NUMBER DRAIN LAYER PERMIT S � �} DATE: asros/2o 19 GIS ID:70700270 FEE: 80.00 MUNIS APPLICATION# 201901708 ' 0 EXPIRATION DATE: 09/07/2019 APPLICA r Z , q �` LOCATION . N w NAME: ATLANTIC EXCAVArI�I RE 7�0'�29PEPIN PLACE/#3 KENNISON CT ADDRESS: 363 PARUM ROAD # " & UII DING CO.,INC. K STREET COLCHESTER,CT ' ' eKw PHONE ti ; 1, KR VAR sff- a WORK DESCRIPTION: BUILDRV�" � • ISNR OURT,270,274, 278,2 01,9 82, THE DRAIN LAYER ASSIGNED TO THIA E* S A' E SS TATE AND HEREBY AGREES TO ALL THE TERMS AND CONDITIONS SET FOR': I�f TTz L� T O F�`' A Ii 4 RK SHALL BE IN ACCORDANCE WITH THE TOWN OF SOUTH WINDSOR STANDA L(3 ?t T 1 1 TSa,v _U ATTACHED CONDITIONS. ,: :. ISSUED I3.Y DATE INSPECTED INSPECTED BY 8/8/20 1 9 2:43 PM I 1 r • f i r i . f ' F • f _ f I 1'QINM©F SQUTN-w9amR N SORT PERMIT NO.;. CONTRACTt7$,-r �� LOCATION; . .. � - f•G� � - TYPE OF VtIQRK: DAtt BYSP N : DATE INSP.� '/z /1 2 l#t INSPECTED•Brf: � er r PROGRESS: �� TANK PUMPEQ SHED; FILLED WrMESSED ❑-YES CI NO- SEPTIC . . . .r. � AS GUILT: k INPUT: DATE: • 4 - 5 5/utcffoy(�or�s 20M TOM of South Windsor.Mp.SE tdN t bgr 14 k it {fI 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: .27,' W;,8 0�„� >d ����Lflt#�, la Street No. Street Name Premises owned by: Name of Firm: Phone: Address of Firm: �' % 7Z. TYPE OF WORK: i .Lay House Drain I,-.- ppair House Drain ; Sanitary Disconnect Lay Lateral for building with connection ; or no connection Lay Main ' Lay Lateral for Commercial/Industrial Buildingg - number of acres Connection will be made with ,PIC-- f Existing Water Supply: Public Water �� Well Proposed Start Date ;3' z 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. _ r I the holder of Drain Layers License No. -r'' 7 . Only holders of P-1, P-7 or W-9 licenses E 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. ,;r20VR. 120 / PLEASE NOTE: IF A SANITARY SEWER LATERAL IS WITHIN 75 FEET OF A WELL IT MUST BE.AIR TESTED E Signe : Print Name: Licensed Drain er Date: standard Forms\Perm1t5\APPUCATION FOR DRAIN LAYERS PERMIT REVISION 3/2016.doc t f TOWN OF SOUTH WINDSOR SANITARY SEWER LATERAL FIELD LOCATION DATE OF CONSTRUCTION: BUILDING ADDRESS : `Z 2�Z-2 � 2 Z 0 STREET Chla SUBDIVISION: NORTH ARROW ! I j I t ! . t 1 i � E t , � 3 -L -�t I I R ; - -- -- -1__ -- - -ci .-- -I �f I I �- t -. f � LLA , o1c. V-1 tl(Ar\ CONTRACTOR PRINT) NAM F C SUPERVISOR (PRINT) wtz- STREET ADDRESS SIGNATURE TOWN STATE ZIP INSPECTED BY TOWN k—2� 3t DATE TELEPHONE NUMBER WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER