HomeMy WebLinkAboutDrain Layers Permit 1201 Twin Circle Dri PERMIT TOWN OF SOUTH WINDSO
PERMIT NUMBER R, C T
u,: DRAIN LAYER PERMIT
DATE: 07/16/08
GIS ID: 90901201 '`
MUNIS APPL '
ICATION# 200801073 ;,,,:"�' "' ������"'"" '
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ADDRESS: 27 MUDDY B 25 'Y`.: $ IILD7N'>:
ROOK R(QAI . "'::`: G 12 201 TWIN CIRCLE D
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1201F:W�'S lT� :. ..: ��:.�<� x�> �. .�.. EI2=;:�,
THE DRAIN L .S dNt; ", .O
AYER ASSIGNE 8f:: ;>s';ulN : ss>..;.,,.E: SYSTEM
D TO THIS 1ERMITA :aAr, >; :;..._; y::...`:. :::
THE TERMS AND CONDITIONS SET FORT„I,II�,:<; LI :t� TAC ":''
I ' I S -T STATE AND HEREBY AGREES TO ALL
THE TOWN OF SOUTH WINDSOR STANDARg"ALL.bT <" °` . ;-
`: I1S'„" L:::VYdTti 'SHALL BE IN ACCORDANCE WITH
•,, s S,"`ANb T I t I"TACHED CONDITIONS.
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ISSUE BY DATE 4""ypE/CTED Y
7/16/2008 9:56 AM INSPECTED BY
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: CONTRACTOR:
LOCATION:
'TYPE OF WORK:
DATE INSP NEEDED: DATE INSP: 7 /11� I o't
INSPECTED BY: AD
WORK IN
PROGRESS:_ Coi --r�c.e.�,r
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INPUT: ( DATE: 17-0
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W/2007 Town of South Windsor INPSEMON REPORT 07
APPLICATION FOR DRAIN LAYER PERMIT
a�p/ ap0$0/073 TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE -
SOUTH WINDSOPt, CT
FEE $60.00
Location of proposed work: art YAC cw00D C aAlD 0
Street No. Street Name ��
Premises owned by: G f&J
T
Name of Firm: SA5 rPs Phone: ?7 :z 13 2-
Address of Firm: (0- 0 60 Y, Z 4 LL G AJ C7-0 N/
TYPE OF WORK:
Lay House Drain ; Repair House Drain >C
Lay Main '
Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with C yC_
Existing Water Supply: Public Water Well
Proposed Start Date wK n` r9-}Estimated time for completion
ALL WORK TO BE IN ACCORDANCE WITH TOWN OF SOUTH WINDSOR S7�ANDARDS,
ALL OSHA REQUIREMENTS AND CONDITIONS ATTACHED TO THE PERMIP 0 p4
Permit is to be issued to —TOk &XA:7�/t the holder of Drain
Layer's License No. -2-0 1-1 z f . Only holders of P-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. -7 0 ?g'�
Signed: Print Name:=//
Licensed Drain Layer
_Date:
standard:Forms\Permb\APPUCATION FOR DRRIN LAYERS PERMIT.doc
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