HomeMy WebLinkAboutStorm sewer Street Cut Permits 565 Foste TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 3400 Contractor H. W. LEVACK CO.
Location Address 49 MASCOLO ROAD
Type Work `" SOUTH WINDSOR CT 06074
e No. (860)528-0131
Date Insp Needed I Av
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Time Insp Needed ,0 a
Inspected By
Work in Progress
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Date ���a`
P mj� No. 3400 Town of South Windsor, CT
Date 09/25/2002 Street Excavation Permit
Expiration Date 09/25/2003
Descrip: FOUNDATION DRAIN INTO C.B
Applicant Location
AN
Name H. W. LEVACK CO. FO ST
Addr. 49 MASCOLO ROAD ,
SOUTH WINDSOR CT STORM
Phone (860)528-0131
Applicant agree e o Wi dsor the amount of bond
required and to re ut for any expenses
incurred by the To nt ,r , rep M c rC in connection with this
permit and that app "T`1 abide by the rules and
regulations for per t n " fn outh Windsor's Street
Cut Permit Manual .
C} A 0
* * PERMIT ALL TIMES.
Issued by '�� �s - le
.01
Date Completed Inspectad By )ae
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm Phone No. S_ 7 sre;;v C� J
Address of Firm
Location of proposed work
Describe fully nature of permit requested
Starting date Approx.time for completion_
Call Before You Dig No. 02Z ? Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing'
!� Pavement Cut
Indicate North Prop. size of cut
No.cuts
Amt. of Deposit$ by
()Cash( )Check#
Cut size after Perm. Patch
No. Cuts
Final Billing $
Amt. Due Payee$
Amt. Due Town $
Appli nt is responsible fo contacting by date
the Police Dept. and C.B.Y.D.
I AGREE TO FURNISH TO THE TOWN OF SOUTH WINDSOR THE AMOUNT OF BOND REQUIRED AND TO REIMBURSE THE TOWN OF
SOUTH WINDSOR FOR ANY EXPENSES INCURRED BY THE TOWN FOR MAINTENANCE OR REPAIR WORK IN CONNECTION WITH THIS
PERMIT AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR PERMITS AS OUTLINED IN THE
TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: 9//
Date:
Title: �t> � D.L.#:
PERMIT SHALL BE KEPT ON]OBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc