HomeMy WebLinkAbout5 Farm Hill Road 1900110 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: I 0/24/2019 k
GIS:ID: 31700005 FEE: 80.00
MUNIS APPLICATION# 201902437 EXPIRATION DATE: 11/23/2019
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APPLICAI�IT r°' 3; J1 LOCATION
NAME: SSC CONSTRUCTION PLC ADDR13S5 `. ,SAKNI HILL ROAD
ADDRESS: 1700 SAYBROOK O 'D k ks OWNER, 0�L ,AND XVIII LIMITED PARTNERSHIP
4 s } ;F k 42 OLI RIDGEBURY ROAD
MIDDLETOWN,Cli 90645 PHONE
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THE DRAIN LAYER ASSIGNED TO THT PIM1 IASLTCENSII ISSL7 ]�BY$I CIE STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FOI11°TN TIIIyATTAGHED`CONDITIONSI LaWORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WIN DSOR STANDARDS,ALL 6SHAEQUIREE1 ,AiD TFTE ATTACHED CONDITIONS.
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S/mat(ay�Tnrms 2d14 Town of South Windsor•MpSjMoN 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 f�r'nj lt,.t 1. 1(0 Lot # -
Street No. Street Name
Premises owned by: —ua►I TO
Name of Firm._- �S�cr�s�� � C , Phone: ?GO. 2S� 2 3 3
Address of Firm: f 700 C-C o6415 7
TYPE OF WORKk- Ri
Lay House Drain pair 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/Jrj
Existing Water Supply: Public Water Well
Proposed Start Date rG z? '°� Estimated time for completion t0 2
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. RM bz erBY/ -ff- 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. Zd l 1 7 7 D-51c1 2— PLEASE NOTE:
IF A SANITARY SEWER LATERAL
IS WITHIN 75 FEET OF A WELL
IT MUST BE-AIR TESTED .
Signed: Print Name: -'Q cvaloo- �®
Licensed Drain Layer
Date:
Standard Farms\Perm1 sWPLICATION FOR DRAIN LAYERS PERMIT REVISION 3/2018.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: /G 19
BUILDING ADDRESS 5 Y�4yy\� {�
STREET : �c -
SUBDIVISION: 65 s � 5vu�ih W-n�_t5u�
NORTH ARROW
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CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPERVISOR (PRINT)
STREET ADDRESS SIGNATURE
CA c69 5.• �,e y DATE
TOWN STATE ZIP INSPECTED BY TOWN
— %c) ZSo. Z73 DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER