HomeMy WebLinkAboutDrain Layers Permits 100 Scantic Meadow (2) 1900065 TOWN OF SOUTH WINDSOR, CT
PERMIT NUmBER DRAIN LAYER PERMIT
DATE: 06/12/2019
GIS ID: 8 1000 100
FEE: 80.00
MUNIS APPLICATION# 201901226 EXPIRATION DATE: 07/12/2019
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APPLICAI>TT lvii LOCATION
NAME: JAMES THROWS DIA „ eveADDRESS ... 160 SCANTIC MEADOW ROAD
ADDRESS: 1330 MAIN STREET' OWNED 1A SIVIER NANCY L
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1�0 SCA! TIC MEADOW R
SOUTH WINDSOR�x PiO607 ,x S
PHONE 860 282 00�5�
WORK DESCRIPTION: NEW S>YNmk CONI;ECTICIIV
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THE DRAIN LAYER ASSIGNED TO THIS'PER HAS A uA) I1 I,ItvEN� ISSUED$T'TH NSTATE AND HERESY AGREES TO ALL
THE TERMS AND CONDITIONS SET FOA TN yHE;;ATTACHED `CbNDI`I IQI�TS' ALL 0ORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDARDS,A�,L OSIAREQUIIEMEI�loss-11' ATTACHED CONDITIONS.
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ISSUE BY DATE INSPECTED INSPECTED BY
6/12/2019 9:47 AM
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TOWIIW OF SOUTH.WIN R IN Off :l'WN REPORT
PERMIT NO.: - CONTRACTOR. :,,
LOCATION: 049. kLaldaAj
TYPE OF WORK:--4
DATE WSP NEEDED: DATE
IN PE S CT
WORK:IN
PROGRESS: (' •��s rt-- r r' ;',�,< ` .c if 'mac:. R
SHED FILLED 1tV1TNESSED ❑YES • 0
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DATE:
S/milioy/torms 2U4 Town aF Sout*h Windsor•Mpaka(jN 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: �,r; >; �:,�.�= ,I �+` ` ` � Lot #
Street No. Street Name
Premises owned by:-
Name of Firm: , - 4j -)eovl 1:-�-L(- Phone: �S-�0
Address of Firm: 13-��) M a)n 4 ` IJI s�
TYPE OF WORK:
Lay House Drains ; 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
Existing Water Supply: Public Water Well
Proposed Start Date N 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�� -ems ��v'� _the holder of Drain
Layer's License No. > - '� _. 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. PLEASE NOTE:
IF A SANITARY SEWER LATERAL
IS WITHIN 75 FEET OF A WELL
IT MUST BE-AIR TESTED .
Signed: Print Name:
ri_���eS
Licensed Drain Layer
Date:._1- Aj,1J 1 1 .._ .
Standard Forms\Perm1ts\APPLICA7ION FOR DRAIN LAYERS PERMrr REVISION 3/2018.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: r;Z 1a Z/-
BUILDING ADDRESS ' 4c)
STREET : 5L
SUBDIVISION:
NORTH ARROW
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CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPERVISOR (PRINT)
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STREET ADDRESS SIGNA E
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TOWN STATE ZIP INSPECTED BY TOWN
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DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER