HomeMy WebLinkAboutDriveway Street Cut Permits 32 Evans Cro 700083 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER
It STREET CUT PERMIT
DATE: 06/15/07
GIS ID:30900032
MUNIS .., s APPLICATION# 200700902
FEE: 25.
00
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DATE:
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A P P L I C A N T.>i>:
NAME: AI ' r" `COCA ROLDIS INC r,:. '' :: '..: TION
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ADDRESS: BOX 71 4 y :. 5: : .32VAN CROSSING
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APPLI
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AGREES TO F URNISH THE TOWN:;DI*> :<. •:::,.::•� .:: .. , � .:
THE TOWN OF SOUTH WINJT1 : !IOIF1 ' F REQUIRED
DSOR FOR AN :;E• NSE . b ,.Y RAT FdI 1kITNTE Q RED AND TO REIMBURSE
CONNECTION WITH THIS PERMIT AND THE':APPT1 '•. ' VI 1NH SILL ABIDE BY THEOR REPAIR WORK IN
FOR PERMITS AS OUTLINED IN THE TOWN OF-OIJI -ET` IJ .. EI MANUAL. RULES AND REGULATIONS
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ISSUED BY DA SPFMD
INSPECTED BY
6/15/200711:09AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: c -' CONTRACTOR:_
LOCATION: in ADDRESS:
TYPE OF WORK: �
DATE INSP NEEDED: DATE INSP:_ aLj jn2
INSPECTED BY:_ ,L
WORK IN
PROGRESS:
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INPUT: O DATE: -C?
� 13 �
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR,CT 06074
FEE $25.00
Name of Firm `�Q `' S �'� - Phone No.
Address of Firm
Location of proposed work
Describe fully nature of permit requested ���� ���' =��`•-
Starting date Z; N ®`� Approx. time for completion �g
Call Before You Dig No. `���`�`�-"�o�oa- Traffic Services Control No.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
Pavement Cut
No.cuts
Est. Size of Perm. Patch(s)
Est. Pvt.Thickness in.
i
Est. Unit Price$
Amt.of Deposit$
Total Due$ by
( )Cash( )Check#
Permanent Patch
No. Cuts
Size of Patch(s)
Final Billing
$
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
PERMIT LINED IN THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: Date: \S\sr)
Title: Driver's License#:
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES