HomeMy WebLinkAboutDrain Layers Permit 982 Main Street f
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TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
IMALUALU -
1940 SULLIVAN AVENUE
SOUTH WINDSOR, CT
TEE $25.00
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Location of proposed work: G 1 f*,� Lot #
Street No. Street Name
Name of Firm: LAVES � `���� �erv�u. C� Phone: ; s
Address of Firm: �J71T Vi ' ^�iQ.� r1 :L`W
TYPE OF WORK:
Lay House Drain ; Ropair Douse Drain ;
Lay Main " ; Lay-Lateral for Commercial/Industrial
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Connection will be made with
Existing Water'Supply: Public Watery Well
Proposed',,Start Date o 1 Estimated,time for diqz a i'
ALL WORK TO OE IN ACCORDANCE WITH TOWN OF SOLTtH WINDSOR STANDARDS,
ALL'OSHA REQUIREMENTS,AND CON.DM-7 0NS ATTACHED TO THE PERMIT
Permit is to be issued to,.lzw the holder of Drain:
( Yer's License No. : Only holders of P1 or P7 licenses will be
issued a permit:= FERMI' WILL EXPIRE THIRTY {30) DAYS AFTE�t_DATE OF
ISSUANCE, The undersigned Drain Layer hereby agrees to all the terms and
conditions set forth ih.the permit end.attached thereto. Applicant has received Town
Street excavation Permit No. and/or ConnDOT Permit No. -
CBYD:No. 41� 1� 3�
Si-ned:, Print Name:
9
Licensed Drain Layer
Date: fivq,,
—� — -_- Stand.fQrm$\PorMitS,\APPLI A1`IQN , zQ R ER.S:PERMIT,094 .
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: v
BUILDING ADDRESS 7
STREET : /'�G9,►
NORTH ARROW
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CONTRACTOR jPRINT) NAME OF CONTRACT R'S SUPERVISOR (PRINT)
STREET ADDRESS SIG URE
DATE
TOWN STATE ZIP INSPECTED BY TOWN
DATE
TELEPHONE NUMBER I _
WHITE - TOWN PINK - CONTRACTOR YELLOW-- CONSULTING ENGINEER / DEVELOPER