HomeMy WebLinkAboutDrain Layers Permit 24 Summerwood Lane • I INS
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APPLICATION-FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR -
PUBLIC WORKS DEPARTMENT
. . - TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, Cr
FEE $60.00
. . LomUOn of proposed work Lot #
Street No. Street Name
Premises owned by: (-� r /I ( - F AS/
-Name of Finn: //77 � r� '•L Plhone• � d (I'1y�1-
AddressofRnn•'Yrl Ls '7 v II C-1 c�,r
TYPE OF WORK:
Lay House Drain__, Repair House Drain
Lay Main - • LRY LalerafforCommerdaVlndusMal
BV00ing of__acres
.
Connection vAl be made with
E>dsung Water Supply., Pudic Water Well
Proposed Start Date - oY Estlmated Ume for Completion - / COZY. .
ALL WORK.TO BE IN XCOMANCE WITH TOWN OF
SOUIN WINDSOR STANDARDS,
ALL OSHA REQUUtBdEN15 AND CONDITIONS ATT, ED TO THE PERMIT -
Pem7ttTsto6elssued.Co twlder of Drain
Lava s Ucense No. Only hollers of P-1,b7 or W-9Ilcens°ee
Will be Issued a perm PERMIT WILL EXPIRE THIRTY(30)DAYS AFTER
- DATE OF ISSUANCE. The undersigned Drain Layer hereby agrees to all the terms
and condiorrs set forth in the permit and attached thereto. Appllgnt has rexhred
Town Street Bcavatlon Pent No. and/or ConnDOT Pent No.
COYD No.
Signed: nsed er Pnnt Name: c Av
Date:
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