HomeMy WebLinkAboutDrain Layers Permit 295 Rye Street (2) 750029 TOWN OF SOUTH WINDSOR, CT
PEWIT NMBER DRAIN LAYER PERMIT
DATP 07n8m7 10
Gh'ID 78600295 'R+4y.ysY1 FEE_- 6000
MUNIS APPLICATION A 200701084 T^' 4 � EXPMYLION➢AI& 08/17/0
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APPLICANT (� 1 LOCATION
NAME POLSOM TREET DCIIONTYC' DR&S R{'H TRENT
ADDRESS SOUTH INDSO r - SHEPARD AS
90LTH WINDSOIt GI060J4 STIJEWEENLY RD
op LD,cro6002
PHONE 860 528RW
WORK DESCRIPTION N6W8E p � ,DN t *v7
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THEDRAMLpYDR p88IPVFA TO THIS flU TH l OSVLD BY E$PATG AND HEREBY AGREES TO ALL
STHETSRMS AKD CONp1T10N88ET FGR jH OCEANB ALL WOIGC SHALL BE M ACCORDANCE WITH
DT04W. OP SDUTH NMD80R 9TA4D E-�{.I R 11RESIENM D THE ATTACflW CONDITIONS
ISSUED BY DAT ECTED INSPL/CTPA BY
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMTfNO:: 7So, CONTRACTOR:
LOCATION: 2 6 S5 ozq 5} ADDRESS:
TYPE OF WORK:
DATE INSP NEEDED: DATE INSP: Z A o
INSPECTED Dy: ao
WORK IN
PROGRESS:a• � a m a - I P � A
INPUT: �'. m _ DATE: /)t/ D8
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APPLICATION FOR DRAIN LAYER PERMIT
06?q TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CI
FEE $60.00
Location of proposed work: Lot #
gStreet No. Street Name
Premises owned by:
nf� lCfrrp w4 C
Name of Finn: &ef' ntin�7L' 5 6 >l[i � Phone: 61Z -ET Z-e
Address of Finn: C 7ke
TYPE OF WORK:
Lay House Dmlrt ; Repair House Drain
Lay Maln ; Lay Lateral for CommerciayIndustrial
Building / of 25 acres
Connection will be made Wth
Basting Water Supply: Public Water ✓ Well / /
Proposed Start Date S O Estimated time for Completion 7 4Le >�(-//
t'
ALL WORK TO BE IN ACCORDANCE WITH TOWN OF SOUTH WINDSOR STANDARDS,
ALL OSHA REQUIREMENTS AND CONDITIONS ATTACHED TO THE PERMIT
Permi � -/ ot is to be Issued to J �>-'/Sdw� the holder of Drain
y
Layers License No. ? . 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 cendlimns set forth in the permit and attached thereto. Applicant has received
Town Street Exavation Permit No. and/or ConnDOT Permit No.
CBYD No. ap07�25'03L(Z�
Signed:
c Print Name: 1 L.-Ul
Licen Drain Layer
Date: 7 L(Z ) 7
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