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HomeMy WebLinkAboutDrain Layers Permit 9999 Avery Street (2) 1900095 TOWN OF SOUTH WINDSOR, CT PERMIT NUMBER DRAIN LAYER PERMIT DATE: 09/I 0/2019 GIS ID: 06309999 MUNIS APPLICATION# 201962008 FEE: 80.00 j EXPIRATION DATE: 10/I O/2019 w t t z APPLICAhTT�4 NAME: DBG CONSTRUCTIQN , t ', LOCATION ADDRESS: P O BOX 393 r 1' LADDRESS` AVEKY STREET TOWN OF SOUTH WINDSOR GRANBY CT 060315 ' 40 aSltILLIVAN AVE Q,r i �4r T: PHONE 860-7 12I8Y 4} ci s t y t Se_. � 1?��•tfV2 `; k .� r`i E WORK DESCRIPTION: NEW SWE LQII�ECfiIO�T H�17SE IS YhT MACIESER THE DRAIN LAYER ASSIGNED TO THI�> P1�;�IIT I AS A'VA,I�t� IC1a?s,JSE ISSUEI3'k�Y T STATE AND HERESY AGREES TO ALL THE TERMS AND CONDITIONS SET FOIFIIIN TII ATTAAED`COTDITIOI�IS' L CORK SHALL BE IN ACCORDANCE WITH THE TOWN OF SOUTH WINDSOR STANDARDS t�I L pSHA RE IJTREMg iTS,AIy[b I. ATTACHED CONDITIONS. Y C k — r ISSUED BY DATE INSPECTED 9/1 0/201 9 2:57PM INSPECTED BY E J 1 � a � t� z � dt'xY 2 �75t i 5 , f y ty yj f V g .. l _f T.oVVW OF SOUrH*.1NIND R�NSP�EC N REPORT PERMIT NO.: .ZY Loca=N: TYPE OF WQRK; I�E'i�J �' C:r�hr►- ram e DATE INSP NEEDED. DACE INSP: INSPFGTED'BY; WORK-IN f. PROGRESS; r! ' tttz tl. . FiZvM S'TJ LZ - - . _. . • �-mvESSEo [].YESQ No� . SEPTTC TANK PUMPED;S. SHED. FILLED AS-BUILT DATE:_;. G IN'UT. REpO1tT 14 S/movo'yJforms 2OL4 Town of South Windsor•3PiP N 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: //e Lot # Street No. Street Name Premises owned by: C*, o 6 X, i/)LI 0!:�o� Name of Firm: (vim S f�� L Phone: Address of Firm: 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 Existing Water Supply: Public Water Well_ Proposed Start Date ? /L 0 Estimated time for completion 7 (3// 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 Fev� Q G45mh the holder of Drain Layer's License No. 02,t�d / —If 7 . Only holders of P-Z, 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 00 3 C 0 M Z PLEASE NOTE: - IF A SANITARY SEWER LATERAL IS WITHIN 75 FEET OF A WELL IT MUST BE AIR TESTED . Signed _ Print Name: Pew Licensed Drain Layer Date:__ Standard Fcrms\Permits\APPL1CATI0N FOR DRAIN LAYERS PERMIT REVISION 3/2018.doc TOWN OF SOUTH WINDSOR SANITARY SEWER LATERAL FIELD LOCATION DATE OF CONSTRUCTION: 9f 13 1�o j q BUILDING ADDRESS I I Ill q (-&r-ab'uxt44a0) STREET : AVEr�,�j SUBDIVISION: f� TNORTARROW f% y�c;© a Do�� 4f ryft' r A WiT - - I I 1 CON RACTOR (PRINT) NAME O�RACTO SUPERVISOR (PRINT) STREET ADDRESS 5� URE r �,✓/� y DATE �� .�L J'..st.�✓1"` � / �IS� TOWN - STATE ZIP INSPECTED BY TOWN L�— _ DATE TELEPHONE NUMBER WHITE — TOWN PINK — CONTRACTOR YELLOW — CONSULTING ENGINEER / DEVELOPER