HomeMy WebLinkAboutDrain Layers Permits 120 Longmeadow Driv (2) 1900102 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 09/26/2019
GIS ID:54670120
MUNIS APPLICATION# 201902172 1, FEE: 80.00
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EXPIRATION DATE: 10/26/2019
APPLICAN5 T tiF, LOCATION'
NAME: SSC CONSTRUCTION LLC
ADDRESS . lid LONGMEADOW DRIVE
ADDRESS: 1700 SAYBROOKI#,OI
z Q1 L LAND XVIII LIMITED PARTNERSHIP
42`
MIDDLETOWN, OLI%RIDGEBURY ROAD
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PHONE
WORK DESCRIPTION: NEW SW �`�01NECTT01 F �f
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THE DRAIN LAYER ASSIGNED TO THIkP%MjtHAS A V;gI,II�I LIG`'ENS ,ISSUED Y H1 STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FOki I1V'THE!ATTA D� ONDIT,IOI�TS',+r L..7VORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDA$I�S,t,I OSHA REC.... —1 MIsI 1TS Al ID TIDE ATTACHED CONDITIONS.
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TO OF SOUTH-VINQSOR.TNSPSC' N REPORT
PERMIT NO,: ��'/C� -- CONTRACTOR: SS.G
LOCATION: /
TYPE OF WORK:
DATE INSP NEEE •
DATE INSP:. � -•3c l l
INSPECTED BY; ;
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S/mcllop/fomns 20L4 Toren 4f Santh Wing ftorMpskMfl REFORT L4
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: f Zo f�r'Iq• a�a�J (J� Lot # �S
Street No. Street Name
Premises owned by: io 8 ro5. --�:n c-
Name of Firm: Phone:
Address of Firm: 1-7_0b CT 6 J-
TYPE OF WORK
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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 6 •s��
Existing Water Supply: Public Water well
Proposed Start Date �-Z�- `� 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 the holder of Drain
Layer's License No.PGm O—E? 41-,,07 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. -Zo 1� 3 4 0"0 6 3 PLEASE NOTE:
IF A SANITARY SEWER LATERAL
IS WITHIN 7S FEET OF A WELL
IT MUST BE-AIR TESTED .
Signed: — Print Name:Licensed Drain Drain Layer
Date: 0 r'• l
Standard Forrns\Permits\APPLICATION FOR DRAIN LAYERS PERMrr REVISION 3/2018.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: 9 o2 -17 --- ° t
BUILDING ADDRESS
STREET : v - e ��/ r-
SUBDIVISION: - y y
NORTH ARROW
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CONTRACTOR (PRINT) NAME OF NTRACTOR'S SUPERVISOR {PRINT)
STREET ADDRESS SIGNATURE
mJo Lt r"f\ L- l C)L'�[S"1 � DATE
TOWN STATE ZIP INSPECTED BY TOWN
DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER