HomeMy WebLinkAboutDriveway Street Cut Permits 1 Christine PERMIT
TOWN OF SOUTH WINDSOR
700107
PEPERMIT NUMBER � CT
STREET CUT PERMIT
DATE: 07/11/07 ""''�' «';::.>,. ry
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GIS ID: 19800001NJ
MUNIS APPLICATION# 200701070 4 FEE:
"E>. 25.00
'IRATION DATE:
.'T /08
AP P L C N
NAME: :::.:
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ADDRESS: BOX `i `}
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SCRIPTION:SC RI T I O N•
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APPLICANT L
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T
ISH THE Tp,,.
THE TOWN OF SOUTH WINDSOR FOR AN: E. D F`RON REQUIRED AND' a IN j TO TO REIMBURSE
CONNECTION WITH THIS PERMIT AND THi :;AY'T'ICp3" „'; , ,; �; ;; .,'
FQA1TTENANCE OR REPAIR WORK IN
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FOR PERMITS AS OUTLINED IN THE TOWN OP.:450U -IVNE
; ,> II ABIDE BY THE RULES AND REGULATIONS
/� U T P I°1IANUAL.
IS UED BY
Dt "I'E>IS :E+-TITS'
7/11/2007 3:24 PM *** INSPECTED BY
PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: CONTRACTOR:
LOCATION:
--------------
TYPE OF WORK:
DATE INSP NEEDED: DATE INSP:��09
INSPECTED BY:_I3p
WORK IN
PROGRESS: Pc�veA _tt
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AS-BUILT:
INPUT: �i�----
W/2007 Town of South Windsor INPSEMON REPORT 07
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APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
TOWN HALL
1640 SULLIVAN AVENUE
SOUTH WINDSOR, CT 06074
FEE $25.00
Name of Firm 4/Rt��l)I -L kx- Phone No. �� -�39 7 6
Address of Firm -U x -7/ LJ r 04,0 sat-- Cr rGo-7
Location of proposed work / C 64167'INC 57, to
Describe fully nature of permit requested Ci'GaB6.w � /il�?-vl
Starting date WILOT Approx. time for completion /°p . C,
Call Before You Dig No. 7 A L O✓ Traffic Services Control No.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
Pavement Cut
No.cuts
Est. Size of Perm. Patch(s)
Est. Pvt.Thickness in.
Est. Unit Price$
Amt.of Deposit$
Total Due$ by
) Cash( ) Check#
Permanent Patch
No. Cuts
I
Size of Patch(s)
Final Billing
$
Amt. Due Payee
$
I
Amt. Due Town
I
BY
i
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
PER MI OUTLINED I�7w
WN OF SOUTH WINDSOR'S STREET CUT PER IT MANUAL.
Signed. �^` Date:e
Title: License
#:
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES