HomeMy WebLinkAboutDriveway Street Cut Permits 94 Deerfield • TOWN OF SOUTH WINDSOR INSPECTION REPORT
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Permit No. 4100 Co4txa.'ct,o::r M&S ,PAVT'NG,..AND SEALING, INC
Location 0094 DEERFIELD LANE �o A'c�dre4b ':'"i:435<:RUC:.XLANb::ROAD
Type Work DRIVEWAYF}U�H WINE9OR 06074
P'hoxle No, f 97)':.64'8
Date Insp Needed
Time Insp Needed I�Fne' Ind'
------- l
Inspected By
:
Work in Progress
t'
-/u//2005
Expiration Date
Town of
Descrip; e 10/07/2006 Street E caVatWon Winds.,,
South
APPlicant
Name
PAVXbIG
Addr. 435 B CKLA AND SALSN 'ZC
Loatyon
SOUTH WINDSO ROAD "t34
IS
Phone (860)648-1915 cT 0607 EERIEL`DIIE
Applicant Work bR2TIF:WAY
required agrees tQ:fur
incurred bnd tO reymbufses fhe: �ywn c Fain
Permit Y the Town Town h Wi
and fir of S4ukh Fyn n scar
re5ulations that aPP3ic�nt mynnee: °r rFxasor pr aeeXmount of bond
Cut Permit ManualermaC ,..as ottt ndT wibh andlk y ccsnnectponses
1 with
thixh TWxsf Sde by th. rules and
* * PER autFa Wiri'ctsY,s Street
Issued by \ MIT
TO BE KEPT ON
B2�� AT TIMES '*<:•:
Date C°
mPleted �"-- - �itje
APPLICATION FOR STREET EXCAVATION PERMIT q I a
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT Permit No.
TOWN HALL
1640 SULLIVAN AVENUE
SOUTH WINDSOR, CT 06074
v�1 FEE $25.00
Name of Firm_3 r � S -Payi N G 4W'D 5�I AIG,f ICPhone No.�
Address of Firm_ c5—vq(f T7f /,Q
Location of proposed work 2�'��, L��,
Describe fully nature of permit requested_ "��fYl Ova 90.1�(11 q� gr�ST<IJ C�
b v.1 V e,Lo Awl
Starting date_ /Q ° //• 0 60� Approx.time for completioit/ ' //•0,5�
Call Before You Dig No. b Traffic Services Control No.
Show sketch of proposed work or famish
Iwo copies of separate Ong Indicate North This osectigm wn of tSo be filled out Windsor
by
t /9kRG� Pavement Cut
No.cuts
0 Est.Size of Penn.PaWs)
Est.PvL Thickness in.
EsL Unit Price
Amt of Deposit
Total Due$ by
( )Cash( )Check#
Permanent Patch
No. Cuts
Size of Paugs)
Final Billing
a
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
PERMIJASUTLINED IN THE T OF S UTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: a Date:_ ° 0
Title:lIh Driver's License#:
PERMIT SHAI I RR IMPT nu Inmerm