HomeMy WebLinkAboutDrain Layers Permit 105 Gorski Drive TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
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DRAIN LAYER'S PERMIT o, 4680
D5 GUrSKt- ter• `" , 19
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer
named herein to perform the work indicated below at
at premises owned by ' �#
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 tw (2) copies of separate drawings.
SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion
Permit to be issued to _ LAI, 1
the holder of Drain Layer's License No.,.-'_ �' 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.
f > )
Signed jy
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 in the name., of the Town of South Windsor:
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Engineering Department _f, Date
Connection Charge._P4d `-, j //:fi j Permit Fee: Paid $ j r f'
Check Number
Issued by '. �i.{ /
Tax Office ?
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INSPECTION � ,�
Date work started "— 7 Date completed '
Sufficient notification recei ed: _ Yes No
Special Conditions
APPROVED-
Inspec or Date
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