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HomeMy WebLinkAboutDrain Layers Permits 84 Longmeadow Drive (2) 1900096 TOWN OF SOUTH WINDSOR, CT PERMIT NUMBER DRAIN LAYER PERMIT DATE: 09/12/2019 GIS ID: 54670084 s FEE: 80.00 MUNIS APPLICATION# 201902035 ik, EXPIRATION DATE: 10/12/2019 APPLICAT� ,,`L ; ' �' 'lh LOCATION NAME: SSC CONSTRUCTI( rl I,L t�DDRESS84 LONGMEADOW DRIVE ADDRESS: 1700 SAYBROOK EO OWN `R '1 s st ©Xl ,AND XVIII LIMITED PARTNERSHIP r F y42 OLL1tRIDGEBURY ROAD MIDDLETOWN,C �6457 Y F xtF r ' n� PHONE ` �, is WORK DESCRIPTION: NEW 5 �k!C?1EINECTit71T 't to ,,. cr • THE DRAIN LAYER ASSIGNED TO THE P MIT IIA ffi LI17�LTCFAb diiSUE ;BY<THE STATE AND HEREBY AGREES TO ALL THE TERMS AND CONDITIONS SET FOR I fiI T I ATTACHED`{070NDITIO T$' "BALL ORK SHALL BE IN ACCORDANCE WITH THE TOWN OF SOUTH WINDSOR STANDARDS,ALL OSHA REQUTREMEN I S,AlkiD ATTACHED CONDITIONS. k � 1 4. ui Qi C M ba ) 6`� / /fib off_ Lam' ISSUED BY DATE INSPECTED INSPECTED BY 9/12/2019 8:40 AM 44 z z Y 2Y YaS 02 �,� F�IY'� �;��,�r isLy -..,` \ ., �Le L ` lr } ir��y:, f F *,,; i• 4 y�f��i 14t 1 1 ,Ix N ka t v� Tt W OF SOUTH WEMIDSORINSPECON REPORT PERMIT NO.: � CONTRACTOR. LOCATION: ) tea(7 TYPE OF WQRK: YI vie DlkTE ItVSP NEEDED: DAZE INSP:. INSPEGTp BY. �L WORK:IN PROGRESS: o Y ��z -- • t'�'t' �i'r.��.. - S, Fes: _ - - i �r 1 Y. • SEPIIC TANK PUMPED,SMASHED;FILLED . • WIMESSED []-YES a NO AS-BQwT. INPUT: ' `'` b-'' DATE: • S/mof[oifMrms ZQi4 Tawn cf south wkukar•INP E�RON 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: M le)nfWl ecd aw 1-7�,`2 Lot # 3 Street No. Street Name Premises owned by: -"Coke G(trr. -T-y1c— Name of Firm: SSA f6,lq C,_ Phone: Address of Firm: 1700 50--(k,rat, ✓try M ��l�h�w-t C^-� aG�Cs� TYPE OF WORK: Lay House Drainepair 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 6 sA2 Existing Water Supply: Public Water k Well Proposed Start Dated << /�+ 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 SQ�uh�� ' the holder of Drain Layer's License No.P01028'7?W 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. 20 c� 3 G Oz t 3 C3 PLEASE NOTE: IF A SANITARY SEWER LATERAL IS WITHIN 75 FEET OF A WELL IT MUST BE-AIR TESTED . Signed: Print Name: -5 tom,� r^ Licensed Drain Layer Date: 47• r (, r 2 Standard FormsWermits\APPLICATION FOR DRAIN LAYERS PERMIT REVISION 3/2018.doc TOWN OF SOUTH WINDSOR SANITARY SEWER LATERAL FIELD LOCATION DATE OF CONSTRUCTION: BUILDING ADDRESS Lo STREET d J SUBDIVISION: � t-T NORTH ARROW PE .- � --f - � i i I kf -...-._...1.__...-.1...._1__. ..I. _ .�_Y�_N �_ t? _t —J T �d — •'—_ _ L _._L,�_ _-- �_ _— SSC C!ni5Afuc .v" I L Iv�.1e_ �,�"r, CONTRACTOR (PRINT) NAME OF NTRACTORS SUPERVISOR' (PRINT) STREET ADDRESS SIGNATURE UtA✓ ioj(a�caw✓� c ( _ U f f X;z TOWN STATE ZIP INSPECTED BY TOWN T&C?- 2 Sd' Z3 -73 DATE TELEPHONE NUMBER WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER