HomeMy WebLinkAboutDrain Layers Permit 107 Tallwood Drive PlI.It Me
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' APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $60.00 /
Locationofproposedwork: 6U7 �sl�woa� , # �
Street No. ' // Street Name
Premisesowned1b/y:_ kAhhl.._ (r, /5on
Name of Firm: Vgd3 pC� e 1 Sqi �: t � L //<Phone;�S
Address of Firm: 97 7l�,cu.� l do Ae Po
TYPE OF WORK:
Lay House Drain -e ; Repair House Drain
Lay Main ; Lay Lateraffor Commerdal/Industrial
Building of acres
Connection will be made with CZAR 35-
EMsting Water Supply: ' �Publlicc Water Well
Proposed Start DateEstimated time for completion 2/ ✓& /G
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 a w.x I�Irdv the holder of Drain
Layer's License No. �nfr . Only holders of P-1, P-7 or WA 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 form in the permit and attached thereto. Applicant has redelved
Town Street Excavation Permit No. and/or ConnDOT Permit No.
CBYD No.
Signed: r✓� Print Name: J°""'s�j�h..,�
Ucensed Drain Layer
Date: l5cf1di nC
SbMmE�rrrA MR DWN DYERS 4ERMR.M[
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