HomeMy WebLinkAboutDrain Layers Permit 310 Tamarack Avenue (2) Peelle No i101
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TOWN OF TIE DE WINDSOR INSPECTION REPORT
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APPLICATION FOR DRAIN CAPER PERMIT
TOWN OF SOUFH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULUVAN AVENUE
SOUTH WINDSOR, Cr
qq''FEE/u,,$60.00 I '
Location of proposed work: L,G 4 +� Oy~ La #_
Street Nno. Sbeet Name
Premises owned by: J-t9(r .t��
Name of Arm:lt .r 49(Y%Me7ft-) 6665W Phone:yk
Address of Finn: „%t//�.diP[71f�ECY . fl/IPT!APD CY/?E`
TYPE OF WORK:
Lay House Drain ; Repair House Drain
Lay Main ; Lay Lateral for Commercial/Industrial
ang MA of acres
connection will be made witlC�NL3!SAd ft/�j'((�5��/JJ�^x va'a
EBisting Water Supply: Public Water Well
Proposed Start Date Estimated bme for completion
ALL WORKTO BE W ACCORDANCE WITH TOWN OF SOUTH WINDSOR STANDARDS,
ALL OSHA REQUIREMEW,,SSypAN�D CONDTUONS ATTACHED TO THE PERMIT
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Permit is to be issued M F39//ft/ 5R th Ider of Drain
Layer's Ucense No. dfA�$Ckf Only holders of P-1 F-J W-9 licenses;
will be issued a permit. PERMR WILL EAPIRE THIRTY (3D AYS AFTER
DATE OF ISSUANCE. The undersigned Diam Laya hereby agrees to all Me terms
and conditions set forth In the permit an ched thereto. Applicant has received
Town Str Exc Mon Penult No. and/or ConnDOT Permit No.
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CBYD N0. Z566X30-IA97
Signed: f !. Print Name:�M�l)� ,NPFI7.7r�//�rSR
Lice//n��sed rain yer
Date: /0%2r/
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