HomeMy WebLinkAboutDriveway Street Cut Permit 34 Doria Lane 700036 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER
STREET CUT PERMIT
DATE: 04/24/07
GIS ID:28800034 ;>
MUNIS APPLICATION# 200700505 FEE: 25.00
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ATE: 04/23/£,. 08
AP P LI CA N
L O= CA TI O N
NAME:
P AG ANI C NS TR UC TT
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"34ORIA?<Z ANE
ADDRESS: 15 KING STREET
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VERNON ROCKVILLE'``T ::. <.. AN&SHEYDA
4I0 LANE
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PHONE R,CT 06074
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SCRIPTION:
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APPLICANT AGREES TO FURNISH THE QWI�I°pi��S0-UT1 ° =`" . ': %` ' '
THE TOWN OF SOUTH WINDSOR FOR ANC' E QF B£)ND REQUIRED AND TO REIMBURSE
P.ENSI � D,Pi ' I:.T()'t?N FC1 ;:1vf1NTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND TH1'AP„P:.,' TCA1 . 5lit
'TkI"iiD III 'ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN 01"S'bvi f IN] R? PET C.I�I I2MImll
MANUAL.
ISSUED BY DA INEED INSPECTED BY
4/24/20073:55PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: a��-� CONTRACTOR:
LOCATION: 3 H �02�' ADDRESS:
TYPE OF WORK:_ r Q-e u-)"
DATE INSP NEEDED: DATE INSP: 3 f
INSPECTED BY: i?b
WORK IN
PROGRESS:-
,INPUT:— C��--
DATE• 3 > O
APPLICATION FOR STREET EXCAVATION. PERMIT 7cco- %
TOWN OF SOUTH WINDSOR Permit PUBLIC WORKS DEPARTMENT
TOWN HALL
1640 SULLIVAN AVENUE
SOUTH WINDSOR, CT 06074
r FEE $25.00
Name of Firm - Phone No. ® � L-
Address of Firm (5 1
Location of proposed work dot, ;,. c'sSj 3i
Describe fully In re ot4jrmit r uested
Starting date
Approx.time for completion
Call Before You Dig No. Traffic Services Control No.
Show sketch of proposed work or furnish
two copies of separate drawing Indicate North This section to be filled out by
Town of South'Vindsor
Pavement Cut
"' L No.cuts
Est.'Size of Penn.Patch(s)
i
Est.Pvt.Thickness in.
Est.Unit Price$
Amt.of Deposit$
Total Due$ by
( )Cash( )Check#
Permanent Patch
No. Cuts
Size of Patch(s)
Final Billing
Amt.Due Payee
Amt Due Town
By
Applicant is re nsible for contactigg
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 WINDS ANY EXPENSES INCURRED BY THE TOWN FOR MAINTENANCE OR REPAIR WORK IN
CONNFPCfION W T PER AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR
PERMIT$AS O IN T TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed:
Date:� �
Title:
Drivers License#:
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES