HomeMy WebLinkAboutDriveway Street Cut Permits 21 Homestead 700080 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 06/13/07 l
GIS ID:44700021
FEE:
MUNIS APPLICATION# 20070088 `' '< 25.00
9 rw =:E :IRATION DATE:
06/12/08
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APPLICANT'' ....... .:.. .
`LOCATION
NAME: UAL ITY PAV Q ING C( x
,. r- IOMESTEAD DRIV
ADDRESS: 194 S. -:;>>;. '>.:' ::. E
MAIN STREET? t�'f �ti,��'rs=.:�...
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EAST WINDR, $
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WORK DESCRIPTION: D RIVIEW , ..:...i
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APPLI
CANT
CAN TA AG
REES
ST OF FURNI
SH THE TOWN:` ' �f1'1JT�
«_ . :''` UII Qk`BONS REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR AN`�:EEN3 INTENANCE OR REPAIR WORK
.:I3 IT ,T ,j'FjI;I�It IN
CONNECTION WITH THIS PERMIT AND THE:APPTCA]t I,:IS.FI :: L >gBIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED
�IN�THE TOWN OI$ .b t'm.�V1Nb�°I' `' I`'`GCJ'T:1?FRMI:T MANUAL.
ISSUED BY 01
DACE'" RPE `M INSPECTS Y
6/13/20074:OOPM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: 2D 00 9® CONTRACTOR:Qu
LOCATION:_ I j-Ip � a ,� ADDRESS:
TYPE OF WORK: lk'�
DATE INSP NEEDED: DATE INSP: j®q
INSPECTED BY: &D
WORK IN
PROGRESS:
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INPUT: DATE: a
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT 06074
FEE $25.00
Name of Firm
phone No.
Address of Firm ellI Ci
Location of proposed work `
Describe fully nature of permit requested
Starting date
Approx.time for completion
Call Before Y u Dig No 2,k7Z3C1 Traffic Services Control No.
Show sketch of proposed work or furnish
two copies of separate drawing Indicate NorthFNo.
is section to be filled out by
Town of South Windsor
ment Cut
ts
Est.Size of Perm. Patch(s)
Est.Pvt.Thickness in.
Est.Unit Price$
Amt.of Deposit$
I Total Due$ by
( )Cash( )Check#
Permanent Patch
No. Cuts
Size of Patch(s)
Final Billing
Amt.Due Payee
Amt.Due Town
By
Applicant is responsible for contacting 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:
Date:
Title: Driver's License#:
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES