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FROM :CRSLE - ECHN FAX NO. :186060B"e7 Nw. 16 2005 12::00PN P2
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APPLICATION FOR DRAIN LAYER PENOT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOLITH WINDSOR, CT
FEE $60.00
Lp tlon of proposed WorK: L6� IAMAR r, , AVL
Street No, Street Name
Premises owned by: NZU,W
Name of Firm( SIMSCROFT-ECHO FARMS, IN
--P-2 RaK RAI -I PAnt Rnqd Phooe: 86o GS8-2GI(a
Address of Finn: Simsbury, CT 06070 J
TYPE OF WORK:
LaY House Drain Repair HWsa Drain
BBullcing�of Ylateraf l/Industrlal
j, a Commerda
__ cres -
CDIlneetlon will be mark mth
Usting Wales Supply: Pubftc Water-- X _ WeE
Proposed sort Da - .L-o.�Estimated time for compfetlen
ALL WORK TO BE IN ACCORDANCE WITH TOM OF SOUTH WINDSOR STANDARDS,.
ALL OSHA REQUIREMENT$AND CONDITIONS ATTACHED TO THE PERMIT
Permit fs to be issued m �� ;et E Cam, ' d. the Wider of Drain
Layer's Uense No. .2og Lf 9 OnN holders of P-1 p,ZOr W-9I(ce0sey -D be issued a permit PERMIT Will EXPIRE THIRTY(30)Y)AYS AFTER
DATE OF ISSUANCE, The undersigned Drain layer
and conci tlons set fortis in the Permit and attained tllMhete, agrees la ell tha terms
TOM Street E u:in atfon Permit No. APPIIOam has rmit No.
aM/or ConnDOT Permit No.
CBYD No. 20oS5ay p 16 gI
Signed: G'+- -1L^lI Print Name: r A4ie.L t-_
licensed Drain layer ✓d
Date: II- 1(a- 00
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