HomeMy WebLinkAboutDrain Layers Permit 56 Deerfield Lane TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 7897 �C M
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Location 0056 DEERFIELD LANE
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Type Work NEW SAN LAT >�` RSI,E DRITE
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Permit No. 7897 `'"'" »;:.. Town of South Windsor, CT
Permit Date 005 04 04 2 :f:><.` bvN,
/ / ,Drain Layer Permit
Expiration Date 05/04/2005
Descrip: INSTALL HOUSE LAT.�f2ATy'r
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Applicant
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Name
a e JAM ES THR OWE
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Addr. VANS SEWER & S PiT1C .> `• .:fir ' AV> hI'E 7:0 LLEN
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The Drain La er'=';a.s: e:]"":t'lis` >Zi"thfff: f<> j''
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state and hereby .'re. g
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attached 'Condition4:' A.11`<:sa4`rkr"` ar3an ' wa.tk� .own of South
Windsor standards, a1.1 .da-hp,`'k-ec�us s "f :,a tt r.t`'iie a; ta.ehed ::conditions.
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Date Inspected ............... Inspected By --_.......................
APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $60.00
Location of proposed work: jam ' Lot #
Street No. Street Name
Premises owned by:
Name of Firm:
Phone. S
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 S 12 3 S'
Existing Water Supply: Public Water )< Well
Proposed Start Date �OS Estimated time for completion A0 I?O
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 �Gvn.( the holder of Drain
Layer's License No. 2� 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/or ConnDOT Permit No.
CBYD No.
Signed: Print Name:!
Licensed Drain Layer
Date: / �G
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc
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