HomeMy WebLinkAboutDriveway Street Cut Permit 15 Alison Dri •^ I Permit No. 4040 Town of South Windsor, CT
Date 07/15/2005 Street Excavation Permit
Expiration Date 07/15/2006
Descrip:
ApplicantTsoeaton
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Name M&S PAVING AND StA3;ING,y
Addr. 435 BUCKLAND RUAD
ND S O R C T:.. 0 07 4 ;:.•::.;.;...:o£...Wc3rk="'�.12:1`��yVAY
SOUTH WI
Phone �86064 8-
1 915
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Applicant a ree`� .to; �tx��'9�rth `
eV amount of bond d
required and to reimburse Gh Tow�k tr-GI`� dsor for ax}yxpnses
incurred by the Town fo.r'"�a3,xi�en ry >: -r". � -W.X , f "co3lrie'u�t On with this
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permit and that app' i 'ant i -`familiar with and w:. m AEby the rules and
regulations for perrifit`s ae olfine ;# # i n pf S<aaatIi Windoor's Street
Cut Permit Manual. " >"
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PERMIT TOjCFPT:;?bIT'% �7:$>;z%ST1` <:F'1LL"'PME":
ie
Issued by " «' t e ----------
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Date Completed "`""""'``"`�
---------------- inspected By
TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 4040 C ntX7aa t�- M&Sz. 1 S�1IJG o$ND SEALING, INC
Location Qt3 `, ': A ' k. etig FF.
Type Work DRIVEWAY
.35 BL .K AND 12QAD
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;� «r: fiQUP'W. ,N1SE#)R CT a:06074
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Date Insp Needed < .. s.. " ":. '.
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Time Insp Needed
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Input ------=<------ `Date -------------
APPLICATION FOR STREET EXCAVATION PERMIT ��
TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
TOWN HALL
IRO SULLIVAN AVENUE
SOUTH WINDSOR,CT 06074
FEE $25.00
Narne of Firm /� P,0V l N ti c t i N(4 I N Phone No jC &�($'/9�1,�
Address of Firm__ ; /( /-b %,A-b �-
Location of
proposed work uS6
Describe fully nature of permit requested
Starting date_ 7. 1 l • C» Approx.time for completion
Call Before You Dig No. ?raffia Services Control No
Show sketch of proposed work or furnish two copies of separate drawing Indicate North This section
ec_of South 1Mnd out by
or
Pavement Cut
No.cuts
Est.Size of Perm.Patch(s)
l�
— Est.PvL Thickness In.
P Est.Unit Price
AmL of Deposit$
Total Dues by
0
C )cash( )deck#
C� Permanent Patch
No. Cuts
Size of Patch(s)
Final Billing
Amt.Due Payee
a
Amt Due Town
By
Applicant is responsible for contacting Date
the Poke DeM and C.B.Y.D.
t 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 OUTLI ED IN TH TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed,— Date-
Title: rK I T— Driver's License#:
PERMIT SHALL AF KFpT nu-IMMI c R'r At I T..,.