HomeMy WebLinkAboutDrain Layers Permit 100 Arnold Way (3) APPLICATION FOR DRAIN LAYERS PERMIT 68��
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Location of proposed work: /&967 Lot #
Street No. Street Name
Premises owned by:
Name of Firm: Phone: � � q
Address of Firm: 4-
TYPE OF WORK:
Lay House Drainer ; Repair House Drain ;
Lay Main :�, Lay Lateral for-CommerciaVIndustrial
Building of acres
Connection will be made with
Proposed Start Date 9 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/M ,,-�, C P1WMG �1f, the holder of Drain
layer's License No. aa2 77V,�-- Only holders of Pl, P7 & W9 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.
Signed: Print Name
Licensed Drain LdWr
Date:
SCANNED