HomeMy WebLinkAboutDrain Layers Permit 48 Thomas Street P'llit No 80" Town of South WlndBr,
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TOWN OF SOUTH Nxxosou INSPECTION
REPORT
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TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE, OF. CONSTRUCTION: /d//n 0 6
BUILDING ADDRESS : -y$''` l�„m.., ff
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WHITE — TM PINK — WMR4CTOR YElEOW — CONSULTING ENGINEER / DEVELOPER
APPLICATION FOR DRAIN LAYER PERMIT Q
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, Cr
FEE $60.00 -
Location of Proposed work:
Name
Street No. Lot #_ .
Street
Premises owned by: a' . OE'k �
NameofFlrm: OA-tPS ScAnc per: 87f233'Z
Address.of Firm: `✓ o. tax 29 Z� /kuDP/•fT?r,olC IZD -. F,c�/,vG�+✓
TYPE OF WORK: - -
Lay House Drain_1( Repair House Drain
Lay Main . • Lay,Latearfor OommerdaVIndusMal
- . Building of_ ar
Connection will be made With -� . /PVC -
Ekisting Water Supply: Public Water X WelL_;_�
Proposed Start Date !o 7a eb Estimated time for completion is ,A 6.
ALL WORKTO BE IN ACCORDANCE WITH TOWN OF SOUTH WINDSOR STANDARDS,
ALL OSHA REQUIREMENTS AND CONDITIONS ATTACHED TO THE PERMIT
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Layer's Ucense No. 3-��� z oldw �P-Sthe or holder
of Drags -- 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 forth In the permit and attached tttriere agreesApplica
has heton Town Street EKavation Permit No. aM/or ConnDOT Permit No.
. CBYDNo. �T/0,d, �0. �Sd6
Signed� 1`- - Print Name: %Orr GuAk R £jZ�UcenseA Drain Layer
Date: /a/6 i a 6
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