HomeMy WebLinkAboutDrain Layers Permits 129 Longmeadow Driv 1900091 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
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DATE: 08/20/2019
GIS ID: 54670129 v £r
` FEE: 80.00
MUNIS APPLICATION# 201901814 EXPIRATION DATE: 09/19/2019
APPLICANnT F, �� i h LOCATION
NAME: SSC CONSTRUCTIQ LlI,C Y ADDRESS 179 L6NGMEADOW DRIVE
ADDRESS: 1700 SAYBROOKn
AP,
s CpI,hLAND XVIII LIMITED PARTNERSHIP
MIDDLETOWN C1v �LDIDGEBURY ROAD
PHONE r� 4
WORK DESCRIPTION: NEW S� CONICTNG `t� ` sh t i r E t�k rr
THE DRAIN LAYER ASSIGNED TO THIS4EItMI F H,q S A VI II)LIC)NSA ISSUED 1�Y1�III STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FOR �H`IN�'HATTAC. D`G(a1`IbIQ1�dS' R �L 1?[ORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDAWi's ALI.OSI t+;;>ZBe�UIREMl I+1�I S t1'ND TI3$ATTACHED CONDITIONS.
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5/mai(ay/t rmEs 2014 Ta=of Scuth Wkickor.Mp$k dN REPORT 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: {Zest I,v,5 Me4dOL-' 4)�. Lot # 2 3
Street No. Street Name
Premises owned by: C-
Name of Firm: SS e cc�►s��rc� �Ja� t.Cd _ Phone: A6a.2 r0. 2
Address of Firm: 17o c)
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
Existing Water Supply: Public Water � Well
Proposed Start Date r,20. Estimated time for completion r
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 l�ztL-,c-* c— the holder of Drain
Layer's License No. 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
IT MUST BE.AIR TESTED .
Signed: Print Name: rQ 11/4 IT t arm.$7, �®
Licensed Drain Layer
Date:__,
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT REVISION 3/20I8.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS 1 "� ��� �-3
STREET
SUBDIVISION:
NORTH ARROW
MOIL 34
- ---- --
CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPERVISOR (PRINT)
STREET ADDRESS SIGNATURE
DATE
TOWN STATE ZIP INSPECTED BY TOWN
T60, 25a Z,3 13 DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER