HomeMy WebLinkAboutDriveway Street Cut Permits 3 Karen Way 700149 TOWN OF SOU
PERMIT NUMBER SOUTH W I N D S O R, CT
DATE: 09/25/07
STREET CUT PERMIT
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MUNIS APPLICATIO N# 200701537 5 FEE:
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,:�•y APPLIC ANT AGREES TO F > `'`THE URNISH THE TCWN3iTH;:.
TOWN OF SOUTH WINDSOR FOR % OUi 'QF:;BND REQUIRED
Al`TI'' T�J ... £3j F 1 FOIE IkI TNTE QUIIRE AND TO REIMBURSE
CONNECTION WITH THIS PERMIT AND THE AT1N1"`:} I H.; ;< L �E BY THE RULES AND REGULATIONS
` REPAIR WORK IN
FOR PERMITS AS OUTLINED
IN THE TOWN OF S��3I JT T
l' El QUIRhII'1 MANUAL. ULATIONS
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DATE SPECTED '
9/25/2007 2:04 PM *** INSPECTED BY
PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: _7001 V 1`' CONTRACTOR:_ 1 'f 0
LOCATION:_ 3 4 CA
TYPE OF WORK:
DATE INSP NEEDED: DATE INSP:
INSPECTED BY:
WORK IN
PROGRESS: `v
AS-BUILT:
INPUT: CtA_ DATE:
W/2007 Town of South Windsor INPSECTION REPORT 07
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR,CT 06074
FEE $25.00
Name of Firm A 11L20 L"C) Phone No.
Address of Firm P 0 UC k W W l)5� '', C,7' 66 6 7 V
Location of proposed work
Describe fully nature of permit requested
Starting date !� �.�t,61 Approx. time for completion IF-/,G=7
Call Before You Dig No.2-007 3�Yo C O`Zi L Traffic Services Control No. Nt
Show sketch of proposed work or furnish
Indicate North This section to be fitted out by
two copies of separate drawing Town of South Windsor
Pavement Cut
No. cuts
Est. Size of Perm. Patch(s)
Est. Pvt.Thickness in.
Est. Unit Price$
Amt.of Deposit$
Total Due$ by
( )Cash( )Check#
Permanent Patch
No. Cuts
i
Size of Patch(s)
Final Billing
Amt. Due Payee
$
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: � ..� L_� Ic G` ti-`" Driver's License#:
C,
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
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CUSTOMER WORKSHEET
c-, Availability: Days Date
Evening's
Street Other
City How Contacted Map Grid Page
Phone: Home 6`}`'� - �3�3 Work To Be Performed: Remove and Replace
Work Grade and Pave
Cell New Construction
Cap Other
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