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HomeMy WebLinkAboutDrain Layers Permits 242 Oak Street 1900098 TOWN OF SOUTH WINDSOR, CT PERMIT NUMBER DRAIN LAYER PERMIT DATE: 09/17/2019 ,. GIS ID:65400242 a MUNIS APPLICATION# 201902083 >' FEE: 80.00 EXPIRATION DATE: 10/17/20I9 APPLICAI�►TTwi LOCATION NAME: J T P PLUMBING DBA JQ�THE ADDRESS '242 0'AK STREET ADDRESS: 524 SULLIVAN AVE [JIZ"E B =is OWNERA h , i gNFY THOMAS F&HONORA M& " 42 OAC STREET SOUTH WINDSO � � - - PHONERis � `T 00 �Y } i w 3r+.. , y i WORK DESCRIPTION: REPAID HOUSE ?YRAIN t THE DRAIN LAYER ASSIGNED TO THI`"4q P �RIVt�`1 IiAS A VALID I,YEISISE ISSUEb HAY THE STATE AND HEREBY AGREES TO ALL THE TERMS AND CONDITIONS SET FOII wI THE ATTACHED`CONDITIONS 4 LL YrORK SHALL BE IN ACCORDANCE WITH THE TOWN OF SOUTH WINDSOR STANDII3S,t L OSHA REQIREMEN S;A1r1D 1 CIE ATTACHED CONDITIONS. ISSUED BY DATE INSPECTED INSPECTED BY 9/17/2019 2:14 PM i r e t t - rtft� i yy a y , i YQWIM OF SOUTH-WIN"Ol 3NSP. 15 op ItERQRT r PmMTT NO.: - /. CO M. R: I LOCATION; TYPE OF WQ .42 RK: ©ATE INSP NEEI E[ : DATE_*_;-__ INSPEGTED BY: a WORK:IN PROGRESS: C,:w car.. l .rt Ic •ac C i►.. 5C „ 46 C.✓hr.ec fii vt SEPTIC TANK PUMPED,.SMASNED; FILLED �• wrrNESSED []YES a NO AS-BUILT. • - • DATE: INPUT: - 5/mol[o�r/fonzss m1PSN RERORT 14 2014 TQWm of Sots h Windsor• 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 r • Z f �. proposed work. Lot # Street No. Street Name / - f Q 11-1 Premises owned :bY Name of Flrm: :� �''� Phone: v �71 Address of Firm: TYPE OF WORK: 4 Lay House Drain ; Repair House Drain V/ • Sanitary Disconnect p ry . Lay Lateral for building with connections or no connection ; Lay Main- Lay Lateral for Commercial/Industrial 7i1din g number of acres Connection will be made with l Existing Water Supply: Public Water Well Proposed Start,Date l( Estimated time for completion mpletion 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 issue to �t y � -5 the holder of Drain Layer's License 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 4ttached thereto. Applicant has rece Town Street Excavation Permit No. and/or ConnDOT Permit No. 6 CBYD No.C70/ PLEASE NOTE: IF A SANITARY SEWER LATERAL IS WITHIN 75 FEET OF A WELL IT MUST BE-AIR TESTED ��Signed: PrmtN me. "3c� Li ensed rain Layer Date: 911 . Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMrr REVISION 3/2013.doc TOWN OF SOUTH WINDSOR SANITARY SEWER LATERAL FIELD LOCATION DATE OF CONSTRUCTION: BUILDING ADDRESS : �tf aqa STREET SUBDIVISION: NORTH ARROW ' _(vf ;M 77-77 CONTRACTOR (PRINT) NAME ,0 C NRA OR'S SUPERVISOR'(PRINT) STREET ADDRESS SIGNTURE Ile, �e DATE TOWN ` STATE ZIP INSPECTED BY TOWN 06 ` ��/ _ - DATE y f r 0 TELEPHONE NUMBER WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER