HomeMy WebLinkAboutDrain Layers Permit 80 Beldon Road a
TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 7020 Contractor H. W. LEVACK CO.
Location 0080 BELDON ROAD Address 49 MASCOLO ROAD
Type Work NEW SAN LAT SOUTH WINDSOR CT 06074
Rhone No. (860)528-0131
Date Insp Needed —]
Date,
Insp: 7//99
Time I nsp Needed •3. ' N�
4 Time Insp
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Inspected By
Work in Progress
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Inputs Date
Pi4miltw Nq. 7020 Town of South Windsor, CT
Permit Date, 07/19/1999 Drain Layer Permit
Expiration Date 08/18/1999
Descrip:
Applicant Location
Name H. W. LEVACK CO. it."-0080 BELDON ROAD
Addr. 49 MASCOLO ROAD QwnerHLM JANET B
4
SOUTH WINDSOR CT 3601 4,
Phone No. (860)528-0131
The Drain Layer assign®tlrt parrm�t his valid license
this issued by the
state and hereby agrde�e to l t 'tk� t�rmt and; 660 i t�iohs set forth i n the
attached 'C o n d i t i ons .=..A I iko�r k 6Ka, 1 bjo `yi n aoco d4nco with Town of South
Windsor standards, a1 OSHA e5eq Ait",d°,`. end t�$
1� attached conditions.
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Issued By 4ys
Date Inspected pepto , 'By'
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APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Location of proposed work: Jy X, z= ��f/�� Lot
Street No. Street Name'
Premises owned by: ti
Name of Firm: f f � � Phone:
-T2Zf-4a/
Address of Firm:_
TYPE OF WORK:
Lay House Drain ,. Repair House Drain
Lay Main ; Lay Lateral for Commercial/Industrial f
Building of acres
Connection will be made with
Proposed Start Date -`.� stimated 111
r 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 ��T� /j� the holder of Drain
Layer's License No.4222 Only holders of P1, 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: 0 Print Name:
Licensed Drain Layer
Dater
Standard forms\Permits\APPLICATION FOR DRAIN LAYERS PERMrr.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: -'
BUILDING ADDRESS
STREET
SUBDIVISION:
NORTH ARROW
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CONTRACTOR (PRINT) NAME OF NTRACTOR'S SUPERVI R (PRI )
STREET ADDRESS SIG TUR
Q�r ATE
TOWN STATE ZIP INSPECTED BY TOWN
�7 DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER