HomeMy WebLinkAboutDriveway Street Cut Permits 35 Dower Roa • TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 4039
Gbntx q}to M&SK., AXING"%-AND SEALING, INC
Location 003$ DOWER ROAD Rx Acces3 35 Bi :KIND 1tQAD
Type Work DRIVEWAY
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Permit No. 4039 Town of South Windsor, CT
Date 07/15/2005 Street Excavation Permit
Expiration Date 07/15/2006 '
Descrip:
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Applicant y.. y LQC x
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Name M&S PAVING AND SEALING, IATC "" j�` T3t3WETE EGAD e
435 BUCKLAND ROAD ..... t
Addr.. , {
SOUTH WINDSOR ET �5074, ,zs� aWc�xk
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Phone (860)648-1915K',
Applicant agrees to fur` as the Townaf; h Wird�yxk fhe amount of bond
-... W113dsor 0 <<a `"< f snses
required and to rembuxse,'fi`1t+e<Tavti��<.-<'��!%`�
incurred by the Torn fpr-#t1Sk�fensf` fex�rk canns' b!on with this
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permit and that a `'l `ca�?C '3Y� tr:4Miliar.„:;kt< the rules and
pe Pp-
regulations for perrtits as ont,11,1p.ed Yl ' � a n So h-Windsor's Street
Permit Manual.
Cut Pe A � ;
* * PERMIT ;IQ B'�;'C I�Y;::D.1#I" 6. 5'I ...,fly^'ALI"1„-MF.�
Issued by -----
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Date Completed --------------- Inspecte
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR Permit No.
49 PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR,CT 06o74
FEE $25.00
Name of Firm �S PiQV \J( 9L Phone No(
Address of Firm
Location of proposed work
Describe fully nature of permit requested
Starting date __7• I / O�S_ Approx.time for completion I
Call Before You Dig No. Traffic Services Control No.
Show sketch of proposed work or furnish
two copies of separate drawing Indicate North This section to be tilled out by
Town of South Vlfinds T
Pavement Cut
No.cuts
Est.Size of Penn.Patch(s)
Est.PvL Thickness in.
Est.Unit Price$
Amt.of Deposit a
\ Total Due$ by
( )Cash( )Check#
Permanent Patch
No. Cuts
Size of Patch(s)
Final Billing
a
Amt Due Payee
Amt Due Town
a
By
Applicant is responsible for contacting Date
the Police Dept and C.B.Y.D.
1 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 rIIVD IN THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed' Date: ` (/ -a
Title: l T Driver's License#:
PERMIT SHALL RF k-FPT nN-Innan c Av ^i i T....