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HomeMy WebLinkAboutDrain Layers Permit 743 Pleasant Valley w I TOWN OF SOUTH WINDSOR INSPECTION REPORT I Permit No. 7077 Contractor H. W. LEVACK CO. I' Location 0743 PLEASANT VALLEY Address 49 MASCOLO ROAD Type Work NEW SAN LAT SOUTH WINDSOR CT 06074 PhQn� �:No. (860)528-0131 Date Insp Needed �� f,Ate=jIns -:; , Z e_ Q Time Insp Needed Time' Insp ;eg 's' Inspected By " f Work in Progress r - 46a � 1 1 Input _ Date /vI 111 i Permit No. 7077 Town of South Windsor, CT Permit pate 10/25/1999 Drain Layer Permit Expiration Date 11/24/1999 Descrip: Applicant Location Name H. W. LEVACK CO. �Add,r.; 0743 PLEASANT VALLEY Addr. 49 MASCOLO ROAD 1Wner' LUS'SIER NORMAND R + SOUTH WINDSOR CT ;'0,61474, , Phone No. (860)528-01311-- The Drain Layer aas"i ne i±hi's perm-t has a ya'l i d license issued by the state and hereby agrees tp-,,`6 tf#ie �r�'mea; and mot tltitions set forth in the attached 'Conditions ':. ` A I 1 'v?�;rk sha7 1 ..be : n a6'cordanc6 with Town of South Windsor standar al'�1'` ©S! A- requirements; and :tie attached conditions. Issued By , T�it .�q: Date Inspect d Inspected .By _ _ t APPLICATION FOR DRAIN LAYER PERMIT TOWN OF SOUTH WINDSOR PUBLIC WORKS DEPARTMENT TOWN HALL 1540 SULLIVAN AVENUE G�7 SOUTH WINDSOR, CT FEE $25.00 Location of proposed work: _ /� d6ot # Street No. Street Name Premises owned by: N q:j , L tL44-f. Name of firm: G.� 1 �} �_ Phone: �� /' Address of Firm: 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 Proposed Start Date�° `�-� Estimated time for 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 �`� �� � Me holder of Drain Layer's License No. Only holders of P 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:/ Licensg Drain Layer Date: �� y Standard Forms\Permits�APPLICATION FOR DRAIN LAYERS PERMIT.doc w TOWN OF SOUTH WINDSOR SANITARY SEWER LATERAL FIELD LOCATION DATE OF CONSTRUCTION: - �l BUILDING ADDRESS STREET + SUBDIVISION: NORTH ARROW o �J Lv Z_z CONTRACTOR (PRINT) NAME OF CONTRACTOR' SUPERV SOR (PRINT) STREET ADDRESS SIGNA U Tr oo TOWN STATE JA ZIP INSPECTED BY TO 2- 7 z DATE TELEPHONE NUMBER WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER