HomeMy WebLinkAboutDrain Layers Permit Evergreen Way ORO If Death
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TOWN OF WORTH WINDSOR INSPECTION REPORT
KESSIBRE ETR P10
FEE
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APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLNAN AVENUE
SOUTH WINDSOR, CT
FEE $60.00
Location of proposed work:FG 56&k ld/&e,4S"1 Lct F
A Street No. Street Name
Prefnises owned by:N Ad4rF ar/fbr/V
Name of Firm: .C/E5sY.64 ay,(f9d/ur1>Ltt� Phone: &L-73(-rb?Z
Atltlmss of Firm: ly/,(iC�Jr/�F Lmr //mod 4 7-CV10K
TYPE OF WORK:
La House Drain Repair House Draln
Mai Lay Lateral for Commercial/Industrial
Builtlin of� a0'es
Connection will be m�exvtlF FF/ 7j1 tQJd 7dc�t/
Existing Water Supply:: {�P�uJbli�c Water Well
Proposed Start Date /b'/.Ad/Oa Estimated time for cunpl&Ion 0/&4
ALL WORKTO BE IN ACCORDANCE WITH TOWN OF SOUTH WINDSOR STANDARDS,
ALL OSHA REQUIREMENTS AND CONDITIONS ATTACHED TO THE PERMIT
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Permit is W be Issued to N '� 1A the holder of Drain
Layer's License No. "n 5c Onty holtlers of P-l�u W-91lcenses
will be issued a perrntt. PERMIT WILL EKPIRE THIRTY (30 AYS AFTER
DATE OF ISSUANCE. The undersigned Drain Layer hereby agrees to all the terms
and conditions set forth in the permtt a��/d/�atGched therm. Applicant has received
Town S Excavation Fount No. and/or ConnDOT Permit No.
CBY9 No.
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Licensed Inaba L'0
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