HomeMy WebLinkAboutDrain Layers Permit 544 Buckland Road Construction Inspection Report
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APPLICATION FOR DRAIN LAYERS PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE$25.00
Location of proposed work: Ll � Lot #
Street No. Street Name
Premises owned by: ec'
Name of Firm: 4 _ hone: 43
Address of Firm:
TYPE OF WORK:
Lay House Drain Repair House Drain ;
Lay Main ; Lay Lateral for CommerciaVIndustrial,
Building !' of acres
Connection will be made with
Proposed Start Date ff Estimated time for completion �T
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 j G p/z the holder of Drain
layer's License No. a O(d 41! Only holders of P1, 9 W9 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.
Signed: r Print Name �
Licensed Drain Layer
Date: l