HomeMy WebLinkAboutDrain Layers Permit 68 Chase Farm Road APPLICATION FOR DRAIN LAYERS PERMIT d7
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE$25.00
Location of proposed work-L—ILIL Lot # l�
Street No. Street Name
Premises owned by:
N L 77�7 L.U0t
of Firm: 4 �� Phone:
Name
Address of Firm:
TYPE OF WORK.
Lay House Drain_ Repair House Drain ;
Lay Main ; Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with PV
l 2-L-%
Proposed Start Date �-?rEstimated time for completion
ALL WORK TO BE IN ACCORDANCE WITH TOWN OF SOUTH WINDSOR
STANDARDS, ALL OSHA REQUIREMENTS AND CONDITIONS ATTACHED TO
THE PERMIT
j� /� NAVIZ, C7 '"R/U6
Permit is to be issued toJ�;'e 4, ,��f T�t� LSE"' th�hol r de of Drain
layer's License No. 00ZO133+. Only holders of P1, P7 & 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.
S ed: Print Name rCU4- G 'MA-L-22,t
Licensed Drain Layer
Date: �, 2,