HomeMy WebLinkAboutDrain Layers Permits 120 Long Meadow Dri 1900102 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 09/26/2019
GIS ID: 54670120 kk-
FEE: 80.00
MUNIS APPLICATION# 201902172 we EXPIRATION DATE: 10/26/2019
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APPLICANT LOCATION
NAME: SSC CONSTRUCTI s L, ,�, � 4 ADDRESS 120 LQNGMEADOW DRIVE
ADDRESS: 1700 SAYBROOK RHO iD' O VVNER 'Qb)X Y AND XVIII LIMITED PARTNERSHIP
F` _ 2°OLI]RIDGEBURY ROAD
MIDDLETOWN,C`I 06457 y ,'4
PHONES ,
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WORK DESCRIPTION: NEW S �XtCONI�CECTT011 "�'
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THE DRAIN LAYER ASSIGNED TO TH PE`RMT�HA&A�ALTID�,T�i;NSE,IS$UEb BYTA STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FOR.WH`TN THI ATTAGBED ORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDARD$,�LI OSHl RFCUIREMENTS A1D SHE ATTACHED CONDITIONS.
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ISSUED BY DATE INSPECTED INSPECTED BY
9/26/2019 2:58 PM
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PERMIT NO,: CON—RACER:
LOCATION: j ao
TYPE OF WORK:
DATE INSF:. '3f
DATE INSP NEE# l
INSPECTED BY: •��' .. - � -
MAX IN .
PROGRESS: s lam` '
SEPTIC TANK PUMPED;S SHED; FILLED
WITNESSED [].YES El NO'
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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: fQ�g ��� p2. Lot # S
Street No. Street Name
Premises owned by: io k\ '0 r05. Tn c--
Name of Firm: SSC CGrr s n.c�.r� Phone: i
G461"`7
Address of Firm: (�c>d S�.�b��`t n.� �vt.�ep��..;-, �T U
TYPE OF WORK
.Lay House Drain n ; 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 6 ,s011�
Existing Water Supply: Public Water Well
Proposed Start Date `�•ZG• P `� Estimated time for completion r
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 �'�<<-�- �M the holder of Drain
Layer's License No.Pb" Wirf 7,Ftt t-o17 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. -l 3 1 o G l Z 6 3 - 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: Z T.
Standard Forms\Perrnits\APPLICATION FOR DRAIN LAYERS PERMIT REVISION 3/2018.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: 9 ? -° t
BUILDING ADDRESS .
STREET
SUBDIVISION: ' • S<} P ;�
NORTH ARROW
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CONTRACTOR (PRINT) NAME OF . NTRACTOR'S SUPERVISOR (PRINT)
STREET ADDRESS SIGNATURE
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()C-L l S "t DATE
TOWN STATE ZIP INSPECTED BY TOWN
�bd 4-113. DATE
TELEPHONE: NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER