HomeMy WebLinkAboutDrain Layers Permit 37 Sunset Terrace P'llit NI, S6 own If Sense WindSor,
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TOWN OF SCUT, w,NDsoa INSPECTION aneoar
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TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL)) FIELD LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS : Trr a
STREET
SUBDIVISION:
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CONT A OR ((PPRRIING y y/(� NAME OF CONTW70R'S SUPERVISOR (PRIM)
STREET AOORESG SIGNATURE
TOWN srATE ZIP INSPECTED BY Tawu
WlXD1t�t0US /_ Mff
TELEPHONE NUMBER
WHITE — TOWN PINK — CONTRACTOR YELLOW — CONSUL➢NG ENGINEER / DEVELOPER
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:. 37 SunseT Tyr c I of #_
Street No. Street Name
Piemisesownedby: Dovnald Inr
Name of Hrm: 4 p,p s Phone: 0-?46-7%a4
Address of Finn: ZyAiA( s
TYPE OF WORK:
Lay HOusa DMIn, /O�; Repair Hausa Drain
Lay Main_ : Lay Lateral for CnmmerclaVIndustrlal
Building of_ acres -
Connectionwillbemadewith 605DR 3S
Existing Water Supply: Public Water_ Weld_„
Proposed Start Da a4 nS Estimated time for completion g a a o s
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 Ernie koc✓` the holder of DrainLayer's License No. PI-Ao474 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 conditions set forth in the Permit and attached thereto. Applicant has received
Town Street Excavation permit No, and/or ConnDOT Permit No.
CBYD No. O ,
Signed ��`� ✓I Print Name: EnneyT
Licensed Drain Layer
Date: SZa 3 os
SbdN(dms\PamR4UR =ON WR DRAIN LAYERS PMMUAC
Gea 6 �
,�2iz - rizt �,
FAX COVER SHEET
TOWN OF SOUTH WINDSOR
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CONNECTICUT 0 6 0 74-27 66
TELEPHONE: 860 644-2511 jFAX: 860 644-]280
DATE:
PLEASE DELIVER THE FOLLOWING PAGES TO:
NAME: /,n� a �� Fvosd
COMPANY:
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MESSAGE:
Qa,.. L(:1sreA'v'o=-. 2rDal �o -Seoz. I k )
ohs h` ,- Ta S4,.u/- •rei.a�c. -y
If you did not receive all 2 pages (including the cover), or if you have any questions, please
call 644-2511 as soon as possible.