HomeMy WebLinkAboutDrain Layers Permits 460 Miller Road 1900114
PERMIT NUMBER TOWN OF SOUTH W I N D S O R, CT
DRAIN LAVER R PERMIT
DATE: II/25/2019 = -
GIS ID:59700460
MUNIS APPLICATION# 201902747 "
f FEE: 80A0
t } EXPIRATION DATE:
APPLICANT'y s 12/25/2019
NAME: A-1 QUALITY RO M ERDBA JOIN g�ES
ADDRESS: 75 GYPSY LANE q 'i LOCATION
ADDRESS 460 MILLER ROAD
L,. Oi�VNER L41,NA A MICHAEL S&KRISTIN
MERIDEN,CT 06,#q. -�� �160 M LER ROAD
PHONE s „}
WORK DESCRIPTION: t, F
DISCOTSAj CAP S4NITARY SE 4{ f
AVER� ' OUIfiI !ATION FOR DEMO
THE DRAIN LAYER ASSIGNED TO THI4 PFIR IT I AS A ,AL I;ICI;N5 ISSL[EI BY TkTE STATE f .�
THE TERMS AND CONDITIONS SET FORTH'fN THE A
THE TOWN OF SOUTH WINDSOR STANDARDS HED CONI?ITIO7�S' '' (iVO�{SHALL BE INRgCCORDANCE WITH
BY AGREES TO L
L L aSHA REQTTIREIVIEiVTS,AikTD,HE ATTACHED CONDITIONS.
ISSUED BY DATE INSPECTED
11/25/2019 I:05 PM SPECTED BY
r
i
i
Pf �tiyxi G yFr r r .L �aa.e
a
Y s { o-
L
E
F
t
TO�IV1OF'SQDTH.WIND®QRINSP�EON REPORT . .
PERMIT NO.: ! CONTRAG'TUR,
LOCATION:
TYPE OF MAK:
)ATE INS P N�E#�ED; DATE INSP:- �' '.�j
INSPECTED' Cl
. WORK:IN � . - .. - '
t
PROGRESS:
7.74
NK PUMP SMASHED; FILLED aU 1l rMESSED ❑YES Q NO
SEPTIC TA ,.
AS-BUILT:
f DATE; cA
.-
IIV'ltT. - ..
T 14
Sjm41[oyj%nM 2014 7oW of SOUM Windsor INPSE fiON lCEPOR
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:. 460 _H Lot #
Street No, Street Name
Premises owned by: i'c-k cc J an c a
Name of Firm: - ocler Phone: 3
Address of Firm: �-J LC'� e c`cal f �' `f5'O
TYPE OF WORK. �l`�COS �G� GCS Stun C co 5e.w e� (J� jpou4cQc�,�n
Lay House Drain ; Repair House Drain ;
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 It I-Z61A 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 Re-,c s -T R the holder of Drain
Layer's License No. O o�- 1? 7/ 7 7 P 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 II the terms
9 Y Y 9 a
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. 13 Ll 7 n 0 6 PLEASE NOTE:
IF A SANITARY SEWER LATERAL
IS WITHIN 75 FEET OF A WELL
IT MUST BE AIR TESTED
Signed: � :___ Print Name: 70 A VA
Licensed grain Layer
Date: I -2 5 /y .
Standard FomiAPermits\APPLIC4 ION FOR DRAIN LAYERS PERMIT REVISION 2017.doc
c-2 7
I-D J,'170
"vo
IN
le�v
nF
O'C".V
Ij i i 1
O
MONO No
0 NONE Noiii� �'!! I�
■0 Now, m MEN
m man
on MEIN
0 m a m low
■��I� �®i r'A ONE
1t-
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: 11 �
BUILDING ADDRESS cz, .
STREET 64146-(?- Du c:opmv�i
-I- SUBDIVISION:
!NORTH ARROW
�- -- ---- fi ,_ -- .-- ---�- -- - --� -,-
I � I
-44
I a
e I 1
--
r i
r 's i
-44-
CONTRACTOR (PRINT) NAME OF CONTRACT 'S SUPE ISOR {PRINT)
STREET ADDRESS SIGNATURE
M '�7�..�y �� �� �.. � �^ GATE
TOWN STATE ZIP INSP Y TOWN
DATE
TELEPHONE NUMBER
WHITE — TOWN PINK — CONTRACTOR YELLOW — CONSULTING ENGINEER / DEVELOPER