HomeMy WebLinkAboutDrain Layers Permits 94 Longmeadow Drive (2) 1900113 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER
DRAIN LAYER PERMIT
DATE: 11/12/2019
GIS ID: 5467009410,
MUNIS APPLICATION# 201902586 $, ' '` s FEE: 80.00
EXPIRATION DATE: 12/12/2019
APPLICANT ' R '
t w; LOCATION
NAME: SSC CONSTRUCTIO1�irLI�C{ a ADDIl;F, 4 94`LOI rMEADOW DRIVE
ADDRESS: 1700 SAYBROOK R3AD t < 3,, rj t OWNER z TQLJUAND XVIII LIMITED PARTNERSHIP
�; 4 bLD�ItIDGEBURY ROAD
MIDDLETOWN, CT06457>
PHONE
WORK DESCRIPTION: NEW SE WE OCTIOIV 5 f
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THE DRAIN LAYER ASSIGNED TO THIS'PEpil
riIT HAS A uIA LtI;1ISE ISSLIE]7'$YTTLI STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORr1?H IN SHE lTT�CIlY�7 ICC1�Tb TIQI�TS'< aORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDAt I k(SS �UIREMI;NIS,1il{IDZTE ATTACHED CONDITIONS.
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DItT'E INSP NEEDED: DaIE INSP:.
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S/minay/forms 2014Tawn Of sou lh WirtdsorlK4S N REPOW 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: L� 104 pje&,� Lot # 3CD
Street No. Street Name
Premises owned by: a �,� a s n
C. �
Name of Firm: �Se C�✓t SFr�-���� [ t Phone: D Go• ZSrJ, 2 7. 3
Address of Firm: (7c--0 � brGc,P2 '2 0 174-dolc5_7 C c Gey,e-157
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
Multi-Family Dwelling
Existing Water Supply: Public Water Well
Proposed Start Date 12. 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 .71 'r_ic-:1 the holder of Drain
Layer's License No. Of F'7Pf( -! '7 Only holders of P-1, P-7 or W-9 licenses
will be issued a permit. PERMIT WILL EXPIRE THIRTY (30) DAYS AFTER E
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. 2c� 1 6( 3 PLEASE NOTE:
IF A SANITARY SEWER LATERAL
IS WITHIN 75 FEET OF A WELL
IT MUST BE AIR TESTED
Signed: Print Name: Sa i"c-4r�
Licensed Drain Layer
Date:—( i• (�- - 12
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT REVISION 10/2019.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: fi
BUILDING ADDRESS
STREET : � ��� ` � ��21A.
SUBDIVISION: J.j 0
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CONTRACTOR (PRINT) NAME OF CO TRACTOR'S SUPERVISOR (PRINT)
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STREET ADDRESS r SIGNATU E
' DATE
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TOWN _jy� STATE ZIP INSPECTED BY TOWN
DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER