HomeMy WebLinkAboutDrain Layers Permits 32 Shepard Way 1900107 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER
DRAIN LAYER PERMIT
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DATE: 10/15/2019
GIS ID: 82600032 FEE: 80.00
MUNIS APPLICATION# 201902351 s y; EXPIRATION DATE: 11/14/2019
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APPLICAIT4 k�r ; 's LOCATION
NAME: ATLANTIC EXCAVA N.INC ADDRESS 3� SHEPARD WAY
ADDRESS: 363 PARUM ROADS i FV4i. �VNER T 8c MBUILDING CO.,INC.
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WORK DESCRIPTION: NEWVIR GCNNCTI01� t
r.. ,F THE DRAIN LAYER ASSIGNED TO TIN PENi4 H AND HEREBY AGREES TO ALL,
THE TERMS AND CONDITIONS SET FORWIVIN TH ATTAC D` QNL?IT QNS'' 1 VORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDARDS,t1L� OSHA T1 (�UIREIIEN 1 S; YND THE ATTACHED CONDITIONS.
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PERMIT NO.: .I9 CSC) -c� ' CO R: ,
LOCATI�N: .3.,� 5 die. kL
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DATE INSP NEEDED: . 111E INSP:. .
INSPECTED'
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SEPTIC TANK Pt1MPED,SMASHED; FILLED. ` • wAESSED ❑YES El NO
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DATE:• '
5/mclby/t'o s 1a14Town of South WindsorINPS 1 ��RY 14
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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: '5'W � (�� Lot #
Street No. Street !Name
Premises owned by: ,'f
Name of Firm: �� `c �� Phone• ��- ��' //7�
Address of Firm: �,��,�, �,�- ,• �' y
TYPE OF WORK:
Lay House Drain 1/; 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 (�7
Exxi.sting Water Supply: Public Water � Edell
Proposed Start Date /�/2 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_ � C � �. 7� 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/oar ConnDOT Permit No.
CBYD No. ra% ,�f S' ,� PLEASE NOTE:
IF A SANITARY SEWER LATERAL
IS WITHIN 75 FEET OF A WELL
IT MUST BE-AIR TESTED .
Sign Print Name:
Licensed Drain er
Date:
Standard Fcrms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT REVISION 3/2018.doc
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TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION:
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SUBDIVISION:
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TOWN
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DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER