HomeMy WebLinkAboutDrain Layers Permits 126 Longmeadow Driv 1900106 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 10/11/2019 5;
GIS ID: 54670126 "
FEE: 80.00
MUNIS APPLICATION# 201902328 EXPIRATION DATE: 11/10/2019
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APPLICANT
LOCATION
NAME: SSC CONSTRUCTI r
Q I�LC ADDR);S3 . 126 LONGMEADOW DRIVE
ADDRESS: 1700 SAYBROOK 1Or OWNERO�,LLAND XVIII LIMITED PARTNERSHIP
3 42 OLIO RIDGEBURY ROAD
MIDDLETOWN, CT'964511� 01
PHONE
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WORK DESCRIPTION: NEW SWnfCQNNCTIOI ;
THE BRAIN LAYER ASSIGNED TO THIrS PF1IvIIT HAS Al V. LID> TcIJNs ,IssI1ED 13Y TIE STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FOAXIf 1N THEr ATTACIED`CONDITIONS' LrWORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STAND`' St�L�,bSFTt11IEfL1IREIVIEITfS,,pel1D T'fIE ATTACHED CONDITIONS.
ISSUED BY DATE INSPECTED INSPECTED BY
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PERMIT NO.: y CONTRACTOR: �
LOCATION:
TYPE OF WORK. L .420
DATE INSP NEEpED• DATE INSP:. f
INSPECTED BY•
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s/moilayiforms20i4Tom of south vadsor mpsomm REPORT 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: i Z 6 Lot #
Street No. Street Name
Premises owned by: 13 r'S
Name of Firm: S S C Cc�n s Ff����� [C� Phone:
Address of Firm: l7Gc� �G�6►�oah ✓t'> &j de)QJV,*►, -C-Z o 45 1
TYPE OF WORKk_—.- Rea,
Lay House Drain ir 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 d 5-04,
Existing Water Supply: Public Water Well
Proposed Start Date 16,(_( I ' i 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. PZM oC.F7tq( p7 . 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. ZQ 11�13 �o�c Z63 PLEASE NOTE:
IF A SANITARY SEWER LATERAL
IS WITHIN 75 FEET OF A WELL
IT MUST BE.AIR TESTED .
Signed: Print Name:
Licensed Drain Layer
Date: /D cc�• 1
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT REVISION 3/2018.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS
STREET Lv..��c4,;r ,vJ
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CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPERVISOR (PRINT)
STREET ADDRESS SIGNATURE
Z�•c,;`vlik���;�'� L'� ., , _ .G;��-IS � � � �c+ rr�y DATE
TOWN STATE ZIP INSPECTED BY TOWN
DATE
TELEPHONE NUMBER
WHITE — TOWN PINK — CONTRACTOR YELLOW — CONSULTING ENGINEER / DEVELOPER