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HomeMy WebLinkAboutDrain Layers Permits 359 Ellington Road 1900060 TOWN OF SOUTH WINDSOR, CT PERMIT NUMBER DRAIN LAYER PERMIT DATE: 05/28/2019 1 GIS ID:30300359 FEE: 80.00 MUNIS APPLICATION# 201901054 EXPIRATION DATE: 06/27/2019 l APPLICANT 4 , 1 LOCATION NAME: PIERCE BUILDERS,TIG .`� ADDRESS {35I ELLINGTON ROAD ADDRESS: 522 SALMON BROOK STREET OWNE�i ,SC ELL PROPERTIES#344 LLC RIDER CROSSING BLVD#300 GRANBY, CT 06035 r.i x 4 PHONE 860-65 -72$3;1 { x WORK DESCRIPTION: LAY SE'WEr x W..a, `ii t5 ,1 THE DRAIN LAYER ASSIGNED TO THI$'PgR T.,HAS t�VA TD 1 DENSE ISSIJ 13 �'THE STATE AND HEREBY AGREES TO ALL THE TERMS AND CONDITIONS SET FOREtd3` THE;ATI`AC 3ED`C NDITION A,L WORK SHALL BE IN ACCORDANCE WITH THE TOWN OF SOUTH WINDSOR STANDAS,tkX;L OSIA':RI;�UIREMEI'�i25,AN'D TIDE ATTACHED CONDITIONS. k. ' ISSUED BY DATE INSPECTEDINSPECTED BY 5/28/2019 10:04 AM t v ' '.• i` 5 aF , w r S tit s v t, ,3)f t v . i y v 1 s �S ,1 A \1 `tv� �C 7 i ? `` 5, )• lL �' YIN'Li 5 RI .: L Y{t4 H A t 5::. .: r 5 5 5 Y irjk. S tii.• - la. TOfNW©F-SQUTH.WINDSQRINSPEt;nON REPORT PERMFT NO,. CONTOMi R: LOCATION: d ^ • r TYPE OF WQRK: . DATE INSP NE€pED: DATE INSP.-La. INSPECTED BY: Eh VIIORK:IN . L V. ri,e wl i)a. cie.�, PROGRESS: ,3 s 1 i oZ " AnAA44 ' 3/ •� L rye,- �' d2�r:r�L �� . �E:�'�C9-+r/{ SEPTIC TANK PUMPED,.SMASHED, FILLED -.. _ : WrMESSED ❑"YES 0 NO" AS-BUIL.T 11 • t Spnfll(oyffi ns ZM4 Town of south Widdsor,TpSj WN WORT 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: S� �L4'/"_1CgT0'o Fes, Lot # Street No. Street Name Premises owned by: ��'ia�r,�f��L �P6 0776S Name of Firm: Pkrsi?eC, eyIU� tz 5 Phone: 96c 51� Address of Firm: 152 2 ,�A lLM O r.I 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 �crs���^/�► � c / h�c��pL Existing Water Supply: Public Water Well---����c�anr��� Proposed Start Date., 21 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 Rq to-i,D the holder of Drain Layer's License No. F7-m � C)Z-0 R7--P'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.t or CBYD No. 2�� i 9 c�a` ( 3 PLEASE NOTE: IF A SANITARY SEWER LATERAL IS WITHIN 75 FEET OF A WELL IT MUST BE AIR TESTED Signed: Print Name:��02_z Licensed Drain Layer Date: a Standard Forms\PermitsNAPPLICATION FOR DRAIN LAYERS PERMIT REVISION 3/2018.doc i 1