HomeMy WebLinkAboutDrain Layers Permit 75 Tamarack Ave P11.11 me 811S Tell If Stith
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TOWN OF SOUTH WINEEOR INSPECTION REPORT LL
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TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: //-/6 -aG
BUILDING ADDRESS : 7L 72; c/a A�<
STREET . . . . .
�N SUBDIVISION: Lv2�
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CWRPI,CiOR (PRINT) N/NE,O,f 7TOR'S SU (PRIM)
STTTEEf ADDRESS -' HIRE
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TOWN STATE ZIP INSPECTED w TOWN
Zoe, - a,6-72 DATE
TaSWNE WMER
on - TOWN PINK -..CONIR4CTOR FELLOW - CONWLDNG ENGINEER / DMLOPER
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APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SUUNAN AVENUE
SOUTH WINDSOR, CT
FEE $60.00
Location of proposed work: �5 I AnAVAt 4v4, Lot #
sheet No. Street Name
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Premises owned by:�%Pf-//PE 414W1We&r4Vr
Name of Firm: .(�EJ'P[Ek CLV/iP3.Y6//'.3/iJ.4� P1�- Phone: :2%
Address of Fim: ,2A///Ahj'A t"PejW zkf4 /YQ CT oollm
TYPE OF WORK:
lay House Drain ; Repair House Drain
Lay Main ' Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with
Fxisttng Water Supply: Public Water Well
Proposed Sant DaW4� Estimate] time for mmpletbn A461l
ALL WORK TO BE IN ACCORDANCE WITH TOWNDF SOUTH WINDSOR STANDARDS,
ALL OSHA REQUIREMENTS AND CONDITIONS ATTACHED TO THE PERMIT
PennR Is a be Issue] to the holder of Drain
layer's Ucense No. aneTe my holders of P-k P-] or W-9licenses
will be 6sued a permit PERMIT WILL EXPIRE THIRTY (3bl UA'ys 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 Euwation Permit No. and/or C:nnDOT Permit No.
CBYD No. aMffid�5�. ✓
Signed: r. Print Name: / /�,� �/ 4g
Licensed 6W Lay
Data:
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