HomeMy WebLinkAboutDrain Layers Permit 43 Summerwood Lane CTXDN RED,
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TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: I ` 13 — O (o
BUILDING ADDRESS : ID�" ' y �
STREET : SO ANE
SUBDIVISION: Suh, mer Woo
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CONT OR (PMND WE OF CONTWOR'I SUPERAS(IR (MNT)
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TOWN nn - VAA E/ ZIP INSPECTED V TOM
DATE
TELEPHONE NUMBER -
WHITE - TOWN PINK - CMNMAC M YEIIA'M - CONSULTING ENUNEER / DEVELOPER
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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 work: T 3 o1p - Lot #- .
Sheet No. Street Name
Premises owned by: I`brt..nE/c���,« I
NameofArm: Ir) 1 ) l' tiF1�_Plwne: o O7q{
AddressFin o �
TYPE OFF WORK:
Lay House Drain Repair blouse Drain
Lay Main . ; Lay:Lateral for Commercal/Indushial .
Buildlno Lay
Connection will be made with r) q P(/(
156sling Water Supply: Public Water Welt_
Proposed Start Date - ! 3 0{ Estimated time for completion / 0(
ALL WORK TO BE IN ACCORDANCE WITH TOWNOF! WIND R ANDARDS,
ALL OSHA REQUIREMENTS AND CONDITIONS ATTACHED TO THE PERMIT
Permit Is to be Issued to 4C Mn,� ,� I the old of Drain
Layer'ssssuedLicense No. '{ Day holders of P-1, or W-911metms- will be issued a permit PERMITWILL 'EXPIRE THIRTY(30 NAYS AFTER
DATE OF ISSUANCE. The undersigned Dmin Layer hereby agrees to all the terms and conditions set forth In the Permit and attached thereto. Applicant has related
Town Street Excavation Permit No. and/or ConnDOT Permit No.
Signed: Print Name: c dqL� opr
Liven rain Layer
Data
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