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HomeMy WebLinkAboutDrain Layers Permits 114 Longmeadow Driv (3) 1900100 TOWN OF SOUTH WIND S OR, CT PERMIT NUMBER DRAIN LAYER PERMIT DATE: 09/23/2019 GIS ID:54670114 FEE: 80.00 MUNIS APPLICATION# 201902126 EXPIRATION DATE: 10/23/2019 APPLICA T LOCATION NAME: SSC CONSTRUCTIPN-LLG { ADDRESS 114 LONGMEADOW DRIVE AN ADDRESS: 1700 SAYBROOK ROD r OWNER Oir� ;.AND XVIII LIMITED PARTNERSHIP 5 �k2 OLIO.RIDGEBURY ROAD MIDDLETOWN, G'?! 00457 r PHONE �..= V t t WORK DESCRIPTION: NEW S RC ECTIdN t ' k DEN � a THE DRAIN LAYER ASSIGNED TO THYS PFTtMI IAS A V.,AI Ili LICENSE ISSUND:BY TIC STATE AND HEREBY AGREES TO ALL THE TERMS AND CONDITIONS SET FORTI-'1N TH.1 ATTA IED ICOyNDITIONS I LnWORK SHALL BE IN ACCORDANCE WITH THE TOWN OF SOUTH WINDSOR STANDliRI1S, 1LL QSH. ItEfUIRT♦MEI+ITS,AND TTIE ATTACHED CONDITIONS. x 1'` 4 a ISSUED BY DATE INSPECTED INSPECTED BY 9/23/2019 8:35 AM Ni, 1 [ N ,y ...... .... .. 0 aZ "c y, ptm t`il s } .'i ct✓ ' AF F 3 1 ..............;: F f: TownoFEQUrN•.WINDSQRINSP�EC' N REP©RT LM PERMIT NO.: PSI CONTRAC W*. N. LOCATTO -. TYPE OF WQRK: z° DA IMP NEEDED. � wok-,.INroc PROGRESS: CaAli �> ��tis f rl i b SEPTIC TANK PUMPER,SMASHED;FILE-ED: •. WITNESSED ❑'YES [] NO' AS-BUILT:- •� - � - - DATE: • i REPORT 14 s/oomaiv famts2M4Town Of Scuth Wmdsor•INPS N i 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: 1 t'l /On ,_e-4-6c0 OK.L-- Lot # Street No. Street Name Premises owned by: re/5 k O C_ Name of Firm: Phone: 76o. 2 fej.•2 3 / ; Address of Firm: f 7oo CT 0014r-1 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 6 S Existing Water Supply: Public Water well Proposed Start Date Estimated time for completion Zd 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 the holder of Drain Layer's License No. r'/hi of rf 7k4/ n 7 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. Za 1 3 O PLEASE NOTE: IF A SANITARY SEWER LATERAL IS WITHIN 75 FEET OF A WELL IT MUST BE-AIR TESTED . Signed-. Print Name: -S0we-V?_ Licensed Drain Layer Date: Za. t�J Standard Forms\Perm1ts\APPUCAT1ON FOR DRAIN LAYERS PERMIT REVISION 3/201B.doc TOWN OF SOUTH WINDSOR SANITARY SEWER LATERAL FIELD LOCATION DATE OF CONSTRUCTION: 1 0 // 2 BUILDING ADDRESS STREET Meoxt " °; r' SUBDIVIS NORTH ARROW � I 04 ► � . t I t I '-__�...._�..-__i._......�-�._._�..__...1.._.._._.1_._......�._..-+-_____i....._._. _......_�__.._•i........._..?._ .=-�. _ �_�lcr_�I--ice.. �_�_�:^..�.'.^L�._-.-�-._ CONTRACTOR (PRINT) NAME F CONTRACTOR'S SUPERVISOR (PRINT) STREET ADDRESS SIGNATURE DATE TOWN STATE ZIP INSPECTED BY TOWN a 'Y6 -7 DATE TELEPHONE NUMBER -' ""' _..•. .. _ WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER