HomeMy WebLinkAboutDrain Layers Permits 22 Joseph Lane 1900092 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER
DRAIN LAYER PERMIT
DATE: 08/22/2019IN
GIS ID:48000022
MUNIS APPLICATION# 201901858 0" {YY FEE:EE: 80.00
EXPIRATION DATE: 09/2I/2019
APPLICANTij
,i. LOCATION
NAME: WASTEWATER SE ]VICES/DIA SIPS
ADDRESS: 21 COURTNEY DR "* ADDRS 22 JOSEPH LANE
' +OWNER PE
� CA FRANK W&NICOLE L
ELLINGTON,CT 0 (29s ', JOS PH LANE
PHONE
WORK DESCRIPTION: NEW S WE CtTNCTIdIV
THE DRAIN LAYER ASSIGNED TO THIS P {
THE TERMS AND CONDITIONS SET FORIEI�TNI TI�1;q TAGJ�I`Ci7NDITpNg ,DYTHE
��U0 SHALL BE N STATE AND HEREBY AGREES TO ALL
THE TOWN OF SOUTH WINDSOR STANDARDS,ALL OSHA REQIIIREME]•ITS, AMID jfE ATTACHED CONDITIONS.IN RDANCE WITH
ISSUED BY DATE INSPECTED
8/22/20192:41 PM INSPECTED BY
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T.DII N OF SDUTR:WZMOWR=NSRECtiON RIPORT
PERMIT NO.: J CONTRACTOR:
LOCATION: 9L. L
TYPE OF 1NaRK. h
DATE IIVSP NEERED: DATE MR. 1 1
INSPECTED-BY: ,!iD.. . .
MAKIN
PROGRESS:
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SEPTIC TANK PUMPER,SMASHED; FILLED .- WITNESSED ❑-YES if�o
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S/mol(op/forms 2014 Town of South Windsor MPSd7tH REPORT 14
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AF'I'UL A 1 ION 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: ' J`0 P/-/ Z-//7 Pi C Lot #
Street No. Street Name
Premises owned by: v fi ci29 J
Name of Firm: <S "% �,, � ,z Phone: `Y6c, 7�!� z 332-
Address of Firm: 7-1 C,v7 K i7v C,/ D F'4-L
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 ee 57�/ 3 S f VG
Existing Water Supply: Public Water Well
Proposed Start Date '?6 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 1&,"i 4j&-k-CA— the holder of Drain
Layer's License No. 0cl zz- 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. 2 41-0 '1*r6 PLEASE NOTE:
IF A SANITARY SEWER LATERAL
IS WITHIN 75 FEET OF A WELL
IT MUST BE-AIR TESTED .
Signed: _ Print Name: ?r��'
�7� s•
Lkensed Drain Layer
611
Date:
Standard Farms\Permits\APPLICAT1ON FOR DRAIN LAYERS PERMIT REVISION 3/2018.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: ler
BUILDING ADDRESS : r Lin
STREET
SUBDIVISION:
at VI-41
NORTH ARROW
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CONTRACTOR (PRIN ) NAME OF C N RACTOR'S SUPERVISOR (PRINT)
STREET ADDRESS SIGNATURE
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CT e..�, � DATE
TOWN STATE ZIP INSPECTED BY TOWN
DATE
TELEPHONE NUMBER
WHITE - TOWN PINK -- CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER