HomeMy WebLinkAboutDrain Layers Permits 1281 Main Street 1900105 TOWN OF SOUTH WINDSOR CT
PERMIT NUMBER ,
DRAIN LAYER PERMIT
DATE: I0/07/2019
GIS ID: 5490128I
MUNIS APPLICATION# 201902249 r' �;q FEE: 80.00
EXPIRATION DATE: 11/06/2019
APPLICANT, `
LOCATION
NAME: JAMES THROWE Da'A 1 4
ADDRESS: 1330 MAIN STREET ADDRESS I81 1AIN STREET
s t� 54 OWNER r ' w ,s� BONNIE
SOUTH WINDS04'CT'o .p�4 _ I281 N IN ST
PHONE 860-2$9 009rF
y
WORK DESCRIPTION: NEW S'�WE `CONNEC�ION
THE DRAIN LAYER ASSIGNED TO THISi P1vIIT,IASALI LEhCSE ISSUEDr 'fHE STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FOIE H IN T H AT7AII� COIYDITIQNS F '"ALLS�VORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WIIVDSOR STANDARDS,ALt OSHA RECiJ1REIvIEIVTS,AI�1D THE ATTACHED CONDITIONS.
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DATE INSPECTED INSPECTED BY
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10VM OF SOW H-.IARN0WR;"EC'fWN REPORT
PERMIT NO.: • ,02 17 CO R:.
WCATION:� JA 9 /
TYPE OF WORK: 10
DATE INSP NEEDED: DA-E INSP:. w r
INSPECTED BY:-Aa
WOM IN
PROGRESS: G&.
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TANK PUMPED,.5MASHED;FII:�ED WITNESSED - 5 El NO'
SEPTIC.C -
AS-BUILD'.
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DATE: 16-6
Slmclloyib ms ZO14 Tcwm of South Windsor iNPSEL'RON DEPORT 14
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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: j I► 5 Lot #
Street No. Street Name
Premises owned by: i ee GL)c,/S c}
Name of Firm: c S Phone:2L-0,2-2�C4PS
Address of Firm: fnLtl,\ Sfi' 50, -1 s
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 � OC7- Estimated time for completion Div,
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. c)�Q Only holders of P-1, P77 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. Qy 17 � 2-c9� PLEASE NOTE:
IF A SANITARY SEWER LATERAL
IS WITHIN 7S FEET OF A WELL
IT MUST BE.AIR TESTED
Signed: — = Print Name:, iljl L
Licensed Drain Layer
Date:_ 9
Standard Fcrms\Perm1ts\4PPUCATI0N FOR DRAIN LAYERS PERMIT REVISION 3/2018.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: 16� of=`7� 1
BUILDING ADDRESS
STREET : _hell r\
SUB IVISION:
NORTH ARROW r• ,r �
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CONTRACTOR (PRINT) NAME OF CONTRACTOR'S UPERVISOR (PRINT)
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STREET ADDRESS SIG A URE
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TOWN STATE ZIP INSPECTED BY TOWN
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- - -- (.���� y' ,.,. DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER