HomeMy WebLinkAboutDrain Layers Permit 113 Gordon Drive 700161 TOWN OF SOUTH WINDSOR, CT
PERMITNUMBER w STREET CUT PERMIT
DATE: 10/02/07 GIS ID: 36300113 ^-
q f FEE:
.00
MUNIS LIGATION# 200701597 . RATION DATE:
..: � 10/O1/08
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;,.,. � , LOCATION
NAME: CONNECTI ># :::>:... ..
> .: ,: ;. 5 ;.. 1<> 3 G` O
CUT WA ER O
R N DRIVE
ADDRESS: 25 NORTH ROAD ;'<<
:,. � :. >H" VEY R,, 't_ `:: , �. AID &DEBORAH M
EA
ST WIND SOR CT
608
�OND RIVE
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S H.W`IND OR CT 0607
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PHONE -
3 8606 2 -3355
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WORK DESCRIPTION: EMERGENVt� ` R MzYT '
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APPLICANT AGREES TO FURNISH THE 1kQ1.QF"SpI7TVtiIN<`_,<, �E�b: 1T. :> Q'ND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANI'<:EENSE 'IN 'TIyJN FttIAINTENANCE OR REPAIR WORK IN
ti
CONNECTION WITH THIS PERMIT AND THE'`r�PPLIjbAN*T TS'F >:k I :AI�J )WTI L ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF f)JTI "*INDSIj'S§ hREFy -CUT PF�I'IT MANUAL.
ISSUED EfY DATE INSPECTED INSPECTED BY
10/2/20072:08PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
Oct, 2. 2007 12:47PM ;AO.L-. No. 5152 P. 1 wjuuz.uvz
Post-it®Fax Note 7671 Date #of
70 D S 47 PaAas► /
From ',414 f �C ZEET EXCAVATIO[1j p�RMIT
Co,/Dept. �. G1Sd/L Co. GujG' 'SOUTH WINDSOR — ��
Phone# r Phone# DRKS DEPARTMENT Permit No,
Fax# yz/_7.2 8f> Fax OWN HALL# ILLIVAN AVENUE
lllMSOR,CT 06074
FEE $25.00 '
'Name of Firm
Address.of Fhm Phone No. ��-�3SS k �p9
Locaffon ofpmposed a r moc-Vo/c. cf.
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De=be frilly nature of permit reques#od CGc)E
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Call Before You Dig No APPr=time fo
7 Da Pletlorr__
TrafRc Services Control No.
Show sketch of proposed wbric or famish
two ccples of separate drawing dedicate North is sedio fo Tti su
• ���h�ndsor
Pavement Cut
No.cats
ESU Size of Perri.Pat+o o
Est.PvL Tress �
Esl Unit Psice$
Amt of Deposa$
T°Cal Due$ �by '
)Cash( )Check#
Permanent Patch
No. Qft
Size of Patctl(s)
f Arnt:Due Payee
O Amt•Due Town
By
F cant is re nstb[e for conta
the Polrce t and CA.y.D.
I AGREE TO F11RNlgi!TO THE TOWN OF SCIUTH WtNpSOR 1'HE AMOUNT OF BOND_RE01l1RED AND TO REIMBURSE THE
TOWN OF SOUTH WINDSOH FOR ANY
CONNECTION WITH THIS PERMIT AND FAT I AM F INCURRED BY THE TOWN FOR �N1 E�lANCE OR REPAIR WORK IN
PERMS AS o THAT 1 AM FAMI!_tAR WITH AND W�ASIDE BY THE RULES AND REGULATIONS poR
ED fN THE WN OF SOUTHslgn DSOR'S STREET CUT PERMIT MANUAL.
77t1e• Dace: 4
` Drivees License#:
PERMIT SHALL.BE KEPT ON JOBSi•1=AT ALL TIMES
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO ,
CONTRAC FOR:
LOCATION:_ 1I:3 �����`� l� 1 ✓gyp - -
TYPE OF WORK:
Cy
DATE INSP NEEDED: DATE INSP:
INSPECTED BY: f3 0
WORK IN
PROGRESS:_ [5t o All
Ll.Ck
GL\00 WTI'
AS-BUILT:
INPUT: DATE:_ /o s ) tj
W/2007 Town of South Windsor INPSEMON REPORT 07