HomeMy WebLinkAboutDrain Layers Permit 543 Rye Street TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT • a, 4360
/erein
nt to written application, permission is h reby granted o the L' ensed Drain Layer
name to. perfo the workIndicated below atat p owned by
' whose address is
La ouse Drain and to
y Repair House Drain, Lay Main, Other for ,
Familynits, with occupancy or use, 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 Q ^1 C ,
the holder of Drain Layer's License P
y a ois 9s'i- Permit will expire thirty (30) days
after date of issuance. The undersigned Drain Layer hereby agrees to all the -tests and
conditions setforth in the permit and the reverse side thereof. Applicant has received
Town Permit No. and/or CHD Permit No.
Signed
4LLAce_n4 d 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:
Az
engineering Department Date
Connection Charge Paid -�;� � ( '
L4L)- l� �; Permit Fee: Paid $ ;j
Check Number 7)
Issued by
Tax fice
l
INSPECTION
Date work started Date completed
Sufficient notification receive dt Yes No
Special Conditions
APPROVED:
Inspector Date
KLMENT & SON CONSTRUCTIOt�t, INC.
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Kement Drive
` BROAD BR04K, CONNECTICUT 06016
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Tel. (203) 623-3064
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