HomeMy WebLinkAboutDrain Layers Permit Stone Crossing APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00 /
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Location of proposed work: Lot #
Street No. Street Name
Premises owned by:
Name of Firm: Phone: 8w-60-oa31
Address of Firm: a Fa�Ms U�« P Po C�v� �8� S�.�s��.-ti Cr 1-6,6 70
TYPE OF WORK:
Lay House Drain ; Repair House Drain ;
Lay Main ; Lay Lateral for Commercial/Industrial
Building of acres
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Connection will be made with 9ie �,✓Fo �,rrs�,.✓S /�N w�/�caf Se�w� �2ocJ a,. i4D�acetir�J�ta
Proposed Start Date--y// o�. Estimated time for completion (e�dZ,oa
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-1ry,,e/ (5i'eAh-t!1 the holder of Drain
Layer's License No. 2.0 $� a 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.
Signed: - l_T rint Name: 1, 144 r'e I�� %1^�✓�
Licensed Drain Layer
Date: �/ ' vL- O 2..
Standard Forms\Pefmits\APPLICATION FOR DRAIN LAYERS PERMIT.doc
r. TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 04444ft Contractor SIMSCROFT ECHO FARMS
Location Address P.O. BOX 581
Type Work SIMSBURY CT 06070
. one No. (860)651-0231
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Date Insp Needed p
Time Insp Needed
Inspected By
Work in Progress GcJ
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ke t No. 7417 Town of South Windsor, CT
Rermf''Date 05/01/2002 Drain Layer Permit
xpi'ration bate 05/31/2002
bescrip:
Applicant Location 5 {d�cYCla�q
Name SIMSCROFT ECHO FARMS - d�r
Addr. P.O. BOX 581
SIMSBURY CT0
Phone No. (860)651-0231
The Drain Layer a s s as c 1 'cense issued by the
state and hereby agr nd o s set forth in the
attached 'Conditions' . 1 a with Town of South
Windsor standards, al ached conditions.
Issued By 6d xs, �xRef
Date Inspected y �''