HomeMy WebLinkAboutDrain Layers Permit 99 Gorski Drive TOWN OF SOUTH WINDSOR /°. 56
DEPARTMENT OF PUBLIC WORKS &77- 8- Y+J 7
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT v, -
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Pursuant to written application, permission is hereby gr ted tl� the Licensea.Drain Layer
named herein to perform the trwoa .
rk indicated below at - { - ;
at premises owned by t t whose address is
and to
Lay House Drain, Repair House Drain, Lay Main, Other ,
for occupancy or use, with
Family Units, with acres.
Type of Sewage to be connected under this permit: SANITARY SEWAGE ( ), INDUSTRIAL
WASTES ( ), OR ( ) Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
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SPECIAL CONDITIONS
Desired Starting Date. Estimated Time for Completion
Permit to be issued to 14�y
the holder of Drain Layer's License No. ,'tA:;C- 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 the reverse side thereof. Applicant has received
Town Permit No. and/or CHD Permit No.
Signed y
--- Licensed Drain Layer
The above named Drain Layer has a valid license issued by the State of Connecticut and
has filed a satisfactory bond and insurance policy lVi the name of the Town of South Windsor:
71
IVAI
Engineering Depart t Date
Connection Charge Paid ./ r. -j Permit Fee: Paid $
' Check Number
Issued by
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions ire ai-2S a
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APPROVED:
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