HomeMy WebLinkAboutSewer Installation Street Cut Permits 61 700209 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 12/13/07
GIS ID:20400617
" FEE: 25.00
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`'' E ?IRATION DATE: 12/12/08
MUNIS APPLICATION# 200702012 f°
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APPLICANT f_; q , LOCATION
NAME: VMS CONSTRUCT IOI 'CO iEA1NY ; .gin u"DRESN ..6... STREET
ADDRESS: 162 LAKE STREET
LEY a UCE S &AMY B
VERNON ROCKVILL
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<1VtRI OR JUGH CT 06447
PHONE
860_871-
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WORK DESCRIPTIO
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APPLICANT AGREES TO FURNISH THE` 6WN 0 .§ 4 <;;'Y < .:. `;'':OF BOND RE
� � s'r �� ; QUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANC EX PE 'I� TN. gjt,IytAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THB,AAPPIJe xr,T�:F.. . J f TII }I 1D WILL ABIDE BY THE RULES AND REGULATIONS
FOR PERM�IT—S`AS OUTLINED IN THE TOWN OT= t i I WI1 os " i T t7TfPFI"""IT,ivIANUAL.
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ISSUED BY DATE4NS.P:" TED INSPECTED BY
12/13/200712:41PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: CONTRACTOR:
LOCATION:
TYPE OF WORK:
DATE INSP NEEDED: DATE INSP: % .z
INSPECTED BY: AD
WORK IN
PROGRESS: C3�_ ��-�d-� . /1� d_e CLzf +d c 4c,,A
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INPUT: C DATE:
W/2007 Town of South Windsor INPSECTION REPORT 07
APPLICATION FOR STREET EXCAVATION PERMIT ��
TOWN OF SOUTH WINDSOR Permit No.
op PUBLIC WORKS DEPARTMENT
TOWN HALL
t 1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT 06074
FEE $25.00
Name of Firm IMS 6 ej^�S-772.J GTj�„j co
�� ,L Phone No. o Zlf —7�0
Address of Firm LA I- G' S--T-- N)ER �
Location of proposed work G/7 C[.w2ic S
.Describe fully nature of permit requested Glrr JL�, ir�
(-fo..,. -"-T/.•J v
Starting date_
Approx.time for completion_ I A�
Call Before You Dig No. Traffic Services Control No.
Show sketch of proposed work or fumish
two copies of separate drawing Indicate North This section to be filled out by
Town of South'Windsor
Pavement Cut
No.cuts /
Est Size of perm Patch(s)
Est.PvL Thickness in.
Est.Unit Price$
f,
Amt.of Deposit$__
Total Due$ by
)Cash( )Check#
Permanent Patch
No. Cuts
Size of PatcKs)
Final Billing
Amt.Due Payee
Amt.Due Town
By
Applicant is responsible for contacting
the Police Dept.and C.B.Y.D. Date
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 A131DE BY THE RULES AND REGULATIONS FOR
PERMITS AS OUTLINED IN THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: --
Date:
Title: ���%�%:.v7
Driver's License#:
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
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