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HomeMy WebLinkAboutDriveway Street Cut Permits 107 Dart Hil TOWN OF SOUTH WINDSOR INSPECTION REPORT Armit No. 4101 Cont,'r'.a:c`t`or M-& ACING AND SEALING, INC Location 0107 DART HILL ROAD At3dres 435; 3XTCKIAND>,.:;ROAD Type Work DRIVEWAY S;pUTH W'gNL�wOR C'Tl 06074 P'hor�e `t�7o (8�0).648 1�15 Date Insp Needed Time Insp Needed "gym T Inspected BY ji Work in Progress Input .: ,Date Permit No. 4101 Town of South Windsor, CT Date 10/07/2005 Street Excavation Permit a Expiration Date 10/07/2006 Descrip: Applicant LcscaC; on Name, M&S PAVING AND SEALNx 'LNG77 DART 1iLL'�tOyD Addr. 435 BUCKLAND ROAD SOUTH WINDSOR CT 0F074 p Word DRIV$WAY is Phone (860)648-1915 Applicant agrees tcx f'ur}s5h bhe,T:mWn .Q St3u+h Wi2l4st3 tie t�maiznt of bond required and to reimburse the <Town of So4l W16sor fp 4ny ;expenses incurred by the Town for maxzre;en e tad rep 3r rork iri s�nnection with this permit and that applicaa�t #S ' mili with and call aB ie'by the rules and regulations for permits s out:lecl a: the3axi<�sf South Wxndlspr's Street Cut Permit Manual. * * PERMIT/ EPT OIL. t�ET $ &17 AkL TTMHS Issued by -- �� Date Completed APPLICATION FOR STREET EXCAVATION PERMIT TOWN OF SOUTH WINDSOR Permit No. PUBLIC WORKS DEPARTMENT TOWN HALL 1640 SULLIVAN.AVENUE SOUTH WINDSOR,CT 06o74 FEE $25.00 Name of Firm m ? i��Y1dIN am 6 'SC0f,i N(4 /N6Pnone Address of Firm - uGiGL�4-sVI� lv NDSCS�. Location of proposed work / b-7 Describe fully nature of permit requested �fYl U V C rnlU!� R pLR G� > C5T7 RJ G� Starting date O ©5- Approx.time for completion l QS Call Before You Dig No. — Traffic Services Control No. Show sketch of proposed work or fixnish two copies of separate drawing Indicate North Irbis secffon to be Town of South ftdsor fiNed by Pavement Cut No.cuts 0 Est Size of Perm.PaWKS) Est.Pvt.Thickness in. Est.Unit Price$ Amt of Deposit$ Total Due$ by Cash( )Check# Permanent Patch No. Cuts Size of Patch(s) Final Bung 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 E TQW OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL. Signed: Date: �` • d Title Driver's License#: _ s - ------------- F