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HomeMy WebLinkAboutdrain layer permit 71 Dower Road (2) 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:_ / izUr Lot # Street No. Street Name Premises owned by: Name of Firm: �i LI Phone: 2 cCJ S Address of Firm: TYPE OF WORK: Lay House Drain x; Repair House Drain Lay Main : Lay Lateral for Commercial/Industrial Building of acres Connection will be made with _5P 35 Existing Water Supply: Public Water ,)� Well Proposed Start DateAA-L-L/C)? Estimated time for completion a✓© 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 -�W4 the holder of Drain Layer's License No. -,�ag1 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. 'joo Signed: _ Print Name:- Licensed Drain Layer Date: `gAki a I Standard FOrmS\Permit WPUCATION FOR DRAIN LAYERS PERMIT.doc