HomeMy WebLinkAboutDrain Layers Permit 565 Foster Street (2) TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No • 7 82 Contractor H. W. LEVACK CO.
Location "" Address 49 MASCOLO ROAD
Type Work AN T .Y. SOUTH WINDSOR CT 06074
e No. (860)528-0131
Date Insp Needed low <I of
Time Insp Needed 01 C9 PM
Inspected By
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Permit No. 7582 Town of South Windsor, CT
_ Permi-t? Date 09/25/2002 Drain Layer Permit
Expiration Date 10,/25/2002
Descrip:
Applicant
Location
Name H. W. LEVACK CO. ' FOSTER ST
Addr. 49 MASCOLO ROAD ON ENT. , INC.
SOUTH WINDSOR
Phone No (860)528-01
i -
The Drain layer i
ha license issued by the
state and hereby a e ` ll an i ons set forth in the
attached 'Conditiony ' ce with Town of South
Windsor standards, m tached conditions.
C} 0
Issued By
Date Inspected iG ed By
APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $60.00
Location of proposed work: 57 �' Lot #
Street No. Street Name
Premises owned by: R-4vL
Name of firm: 1 ��, ,,�' Phone:sl31
Address of Firm: jheCALA
TYPE OF WORK:
Lay House Drain Y Repair House Drain ;
Lay Main ; Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with
Existing Water Supply: Public Water Well
Proposed Start Date __ Estimated time for completion I/
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 .q'IZ i� the holder of Drain -
Layer's License No.Z ::�9Y9 2- . Only holders of P1 or P7 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.
CBYD No.
— Sign _ — -- - Print--Na-m
Li n ed Drain La er
Date.
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMTT.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL ,
FIELD LOCATION
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DATE Of CONSTRUCTION: "1 J 2
BUILDING ADDRESS
STREET, A4<7rt
SUBDIVISION:
NORTH ARROW
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CONTRACTOR (PRINT) NAME OF CANT TOR' SUPERVI R (PRINT)
STREET ADDRESS SIGNATURE
DATE
TOWN - - STATE ZIP INSPECTED BY TOWN
DATE
TELEPHONE NUMBER
WHITE - TOWN -
PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER