HomeMy WebLinkAboutDrain Layers Permit 42 Summerwood Lane Work
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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
Location of proposed vrorK:_ +fi^ SVMM��4. Wa0 Let:# l �(
Street No% Street Name --`�
Premises owned bpy:� ,xsa�I-/L_ lAU Nameofarm Phone: (,jl- b�9d
TYPE OF WORK:
Lay House Drain � Repair House Drain -
LayMain . a lay Laterarfor Cemmardal/industrial
Building of_acfas
Connection will be made withLC�
FAstin9 Water Supply: Public Water. well
Proposed Start Date 7 /! /n Y� Esilmated ume for tompletlon 7 0
ALL WORKTO BE IN CCORDANCE WITH TOWN OF SOUTH WINDSOR STANDARDS,
ALL OSHA REQUIREMENTS AND CONDITIONS ATiAAACppI/��tED TO THE PERMIT
Permit is to be issued to 101 k'Jo d 14'r f the holder of Drain
Layer's License No. �' . Only hoiden: of P-1; P-7 or W-911cen�
will I)e issued a perm PERMIT WILL - IRE THIRTY (30)'DAY6 AFTER
DATE OF ISSUANCE. The undeislgned Drain Layer hereby agrees to all the terms
and Conditions set forth in the permit aM attached tllereM, Applicant has received
Town Street &ovation Permit No. and/or ConnDOT Permit No. -
CBYD No. —^
Signed: - Pdnt Name. t I�t" � ILJUiwf�
Layer
Date: _._._
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