HomeMy WebLinkAboutdrain layer permit 32409999 Felt Road aye � 2�a9�o66`� Pamir Nam. 9oo�3Z
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: ;! Poaal Lot #
Street No. Street Name
Premises owned by:
Name of Firm:_l S dlnz �e� S�ru- < Phone: hL v Z.
Address of Firm:
TYPE OF WORK:
Lay House Dr in ; Repair House Drain ;
(ZI,_ Lay Main ; Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with T�✓n Od-vk s " cf i A,01 e c'
Existing Water Supply: Public Water Well
Proposed Start Date 6l g 1 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 the holder of Drain
Layer's License No. - El-Al
.0?QRq k. 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.
_ a
`�Signed: ame: � -e u —,
Licensed yer
Date:T
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc
900032 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 06/16/09
GIS ID: 32409999 FEE: 00
NI NIS APPLICATION# 200900669 = = EXPIRATION DATE: 07/16/09
APPLICANT = , LOCATION
NAME: FOLSOM CONSTRUGIQN Ll G., DRESB FELT ROAD
ADDRESS: 138 RYE STREET _ FI TdWN O SOUTH WINDSOR
SOUTH WINDSOR,GT46074 �15�} 111VAN AVE
OJTif WINDSOR,CT 06074
PHONE 860-528 8928-.
WORK DESCRIPTION: SEWER M 1 L WTI
FELT RAMRI 6ii'�0 �
THE DRAIN LAYER ASSIGNED TO THIS PERMIT- HAS A VALj� IEE IS�SUE35I3YIETATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORTIS IWTHE ATTA'CH1VJQMP-A ?ITIO ':"ALA WORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDARP,IS,AI L-OSHA K QT,I�REML�Ts�,A1�IY�T�T ATTACHED CONDITIONS.
ISSUED BY DATE INSPECTED SPECTED BY
6/16/2009 4:02 PM
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