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HomeMy WebLinkAboutDrain Layers Permits 910 Foster Street (2) 1900093 TOWN OF SOUTH WINDS OR, CT PERMIT NUMBER DRAIN LAYER PERMIT DATE: 08/26/2019 GIS ID: 33600910 G y MUNIS APPLICATION# 201901881 FEE: 80.00 IN EXPIRATION DATE: 09/25/2019 APPLICA +ISI'r T}x NAME: SIMSCROFT ECHOrFA " LOCATION M ADDRESS 91"0 F�?STER STREET ADDRESS: P O BOX S81s ' OWNER { �, a °r AI, *RING BUILDERS INC SIMSBURY,CT 06}7�OK r ; �400 CHAPEL RD UNIT OF PHONE €, 8bQ-6 it WORK DESCRIPTION: LATE SR�AT,.Aljr C< ECTIQI�T y kt THE DRAIN LAYER ASSIGNED TO THIS PEItM1T HAS�,YAIsID 11ION $ISSUF�� Y THl STATE AND HEREBY AGREES TO ALL THE TERMS AND CONDITIONS SET Fp1 �H'iN,THI ATTxIGHED` pNLYITIONSI,L 46RK SHALL BE IN ACCORDANCE WITH THE TOWN OF SOUTH WINDSOR STAND AM ALL OSHA RETJIR£M$ (TS,Al*TD IRE ATTACHED CONDITIONS. ISSUE 8/26/201910:10 AM BY DATE IN PECTED INSPECT D BY s s w t Y1 ^1. .5 !k . siMLr S 4,yy s) L,� 1: L E r 4 L < Y .04 5 S w r Y II 1 e T4iNM OF SOUTH.IAnNQSQ►R INSPECtxDN REPORT PERMIT NO.: CONTRACTOR: z - LDCATTON: TYPE OF WORK: DATE INSP NEEDED: _ . DATE INSP _ '' - INSPECI D.BY, $ MAKIN - PROGRESS: �• I cl '• f a,P''SDI �� .���� v 'CSC• - kzof SEPTIC TANK PUMPEQ,.SMASHED;FILLED • • nNESSED ❑ NO AS-BUILT;, ✓j . t k INPUT: Lam, DATE: - — F ' t S/mcttoq/fonns ZM4 ToWn of South Windsor•ViMd P4 NOW 14 F 1 f AH-LILA!1UN 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: FI d 5�4 / Lot # 2- Street No. Street Name Premises owned by: 1 Name of Firm: Phone: ,7 Address of Firm: 2 lei TYPE OF WORK: Lay House Drain V ; 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 rt Connection will be made with Existing Water Supply: tic-�Alater "�, WellProposed Start Datek Estimated time for completion V. 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",I the holder of Drain Layer's License No.'L/n v 2 05; 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. Z a'1 1 2-6 3 PLEASE NOTE: �20 35- 60311 IF A SANITARY SEWER LATERAL IS WITHIN 7S FEET OF A WELL IT MUST BE.AIR TESTED . Signed: Print Name: Licensed Drain Layer Date: Standard Forms\Permits\APPUCA7ION FOR DRAIN LAYERS PERMIT REVISION 3/2018.doc TOWN OF SOUTH WINDSOR SANITARY SEWER LATERAL FIELD LOCATION DATE OF CONSTRUCTION: ` ' ' r1 "� BUILDING ADDRESS U0 Fo.a--e r ' STREET c- : ��' `� ��": � xA- SUBDIVISION: NORTH ARROW J� - -- - - - - �� - 11-v r - 13 I 55 �`:� cps,-, � ��,Q ��,�► cti - e �, '� CONTRACTOR (PRINT) NAME OF pITRACTOR'S UPERVISOR �JNT) Y=4-�.►s U I Ire t? �'� � � , STREET ADDRESS SIGNATu,RV i vr,A 1)LK © 7 0 �.. C�. �� f /i'�� DATE TOWN STATE ZIP INSPECTED BY TOWN 31 ZO 0 DATE TELEPHONE NUMBER T WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER J