HomeMy WebLinkAboutDrain Layers Permits 678 Sullivan Avenue 1900108 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 10/18/2019
GIS ID: 87300678 FEE: 80.00
MUNIS APPLICATION# 201902388 ,j :xsY EXPIRATION DATE: 11/17/2019
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APPLICA l+r` LOCATION
NAME: DRAINWORKS PLi MBm &SEPTIG t1DDRI,SS J678' SULLIVAN AVENUE
ADDRESS: 22 HICKORY HII,LDV OWNERNGUYN TAMMY TAM
SU .LIVAN AVENUE
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ANDOVER, CT 06 lO M
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WORK DESCRIPTION: NEW tW& t]Ii1NECTIOIwT w '
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THE DRAIN LAYER ASSIGNED TO THY PERMIT A
HAS IDi6ICETSI?1.las. }IE STATE AND HERESY AGREES TO ALL
THE TERMS AND CONDITIONS SET FOkWl,k WrTHE AT`I AC D`'GbNbITIdNS'. WORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STAN15 ARld ALA QSRA 1 {i1IRE1 ;iaTT,S,AND T IE ATTACHED CONDITIONS.
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SImillayf forms ZQ14 TM of Sou�Windsar•INPS N IC PORT 14
AI PLLLAA"UN 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: 7 A Lot #
Street No. Street Name
Premises owned by: i~ L e l;
Name of Firm: Phone:
Address of Firm: :�3= 2c tz-0 s ` C r&v,e-"
TYPE OF WORK: b�
.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 PVC f+ ?I rz
Existing Water Supply: Public Water Well
Proposed Start Date a v i 8 Estimated time for completion 1 e 1 1
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. PL m s o-Zb as%,LI - P 7. Only holders of P-1, P-7 or W-9 licenses
will be Issued a permit. PERMIT WILL EXPIRE THIRTY(30) GAYS 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. , 0 t6t 4 t 0 4 11 PLEASE NOTE:
IF A SANITARY SEWER LATERAL
IS WITHIN 75 FEET OF A WELL
IT MUST SE.AIR TESTED .
Signed: Print Name:
icens Drain Layer
Date:
Standard Forms\Permlts\IPPLIGkTION FOR DRAIN LAYERS PERMIT REVISION 3/2018.doc
TOWN OF SOUTH , WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS
STREET S o 1-IUy(:., Ay-r
SUBDIVISION:
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CONTRACTOR (PRINT) _ NAME OF NTRACTOR'S SUPERVISOR (PRINT)
STREET ADDRESS SIG
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d O TIA W NP 29, 0�clt'I
TOWN STATE ZIP INSPECTED BY TOWN
DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER