HomeMy WebLinkAboutDrain Layers Permit 69 High Tower Road i
TOWN OF SOUTH WINDSOR INSPECTION REPORT
Dermit No. 6733 Contractor H. W. LEVACK CO.
Location 0069 HIGH TOWER ROAD Address 49 MASCOLO ROAD
type Work NEW SAN LAT SOUTH WINDSOR CT 06074
Phone No. (860 )528-0131
Date Insp Needed �Pate 1.Tnsp If[2019-1 j
Time I nsp Needed T1 me Thap r_- BFt.owJ
Inspected By
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Inpu Z Date
PermviT-, No . 6i3 Town of >outh Wind:_zior , CT
Permit- Date 11 ,/ 1 '7% 199i Drain i._ayer• Perm-it
Expiration gate 12/17/199 7
Desc:rip. PD 4824
App 1 1 (:ant Loc;at i on
Name H . W. LEVACK GO. Addr. 0069 HIGH TOWER ROAD
Addr . 49 MASCOLO ROAD yawner, JAV)OWIEC FOLLY ANN
I
SOUTH WINDSOR CT 0607'4
Phone No. ( 860 )528-0131
The Drain Layer assigned this permit has a , a l t d #.7 cen e- issued by the
state and hereby agrees to all the terms, .and coriditior�s set tc.rth in the
attac-hed 'Conditions ' . .:Al I ,weir k shall accordance' with Town of Soutrt
Windsor standards , al a. QSHA ; requ i eemc?nts, and tf.,,)pz attached conditions .
Issued By Tj t Q
II�/� l 1 I '� Lc. 0'd Y �� n
Date Inspected ---._- ___�.�1 - ,.
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APPLICATION FOR DRAIN LAYERS PERMIT
• TOWN OF SOUTH WINDSOR
9
PUBLIC WORKS DEPARTMENT G
TOWN HALL £
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE$25.00
Location of proposed work:_ /J7 2LI` Lot #
Street No. Street Name
Premises owned by:
Name of Firm:—,: Zt� -Phone:T
Address of Firm:
TYPE OF WORK:
Lay House Drain Repair House Drain ;
Lay Main ; Lay Lateral for CommerciaVIndustrial
Building of acres
Connection will be made with
Proposed Start Date Estimated time for completion Y
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 / ��// �' the holder of Drain
layer's License No. OaAd SZZZZ Only holders of Pl�" 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: Print Name
License Drain Layer
Date: `-
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: Z :2
BUILDING ADDRESS /6 _
STREET
SUBDIVISION:
NORTH ARROW
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CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPERVISOR (PRINT)
STREET ADDRESS ) � SIG ATURE
c�jJZi�°`S'G C��✓ 2zA 'S, r=:(�/i 1 1 DATE
TOWN STATE ZIP INSPECTED BY TOWN
DATE
TELEPHONE NUMBER
WHITE TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER