HomeMy WebLinkAboutDrain Layers Permit Riverwalk SRD Permit No.
7945
Date 0711 2 0
Permit /
/ O5 Town of South Expiration Date 08/10/2005 ':, 3' `m Drain Windsor, CT
Descrip: INSTALL z.'> ";a Layer Permit
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No 7.94�
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7745
APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $60.00
Location of proposed work Lot #
Street o. Street Name
Premises owned by:
Name of FirmbLSC�M Phone: S - 9
LC,
Address.of Firm:/ c� (1 ,
TYPE OF WORK:
Lay House Drain Repair House Drain
Lay Main ; Lay Lateraf for Commercial/Industrial
Building of acres
Connection will be made with
Existing Water Supply: Public Water Well v
Proposed Start Date ` '� Estimated time for completion
ALL WORK TO BE IN ACCORDANCE WITH TOWN OF SOUTH WINDSOR STANDARDS,
ALL OSHA REQUIREMENTS AND CONDITIONS ATTACHED TO THE PERMIT
Permit is to be issued to f the holder of Drain
Layer's License NoOF �o , _• Onl olders of -1, P-7 or W-9 licenses
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 thereto. Applicant has received
Town Street Excavation Permit No. and/or ConnDOT Permit No.
CBYD No.cUAs-- 2 gno -- Zfa S�
Signed: Print Name: ��
Licensed Drain Layer
Date:_0
Standard Forms\Pennits\APPLICATION FOR DRAIN LAYERS PERMIT.doc