HomeMy WebLinkAboutMoled water connection using patch for w 700219 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT;PERMIT
DATE: 12/20/07 *`-
GIS ID:43500021
FEE: 25.00
MUNIS APPLICATION# 200702054
i, NP1RATION DATE: 12/19/08
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PPLI CANT.>?
'LOCATION
NAME: BARBER UTILITIES LEV
,, ti p,DDRES9%,. °.21 H1:LLSUALE ROAD
ADDRESS ''`:.:.,..,,....
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P O BOX 331
ELLINGTON CT 060 9 >F ;
L;�; LE SD':
r. � ROAD
.VCR SO R I. CT 06074
PH 860872-23
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WORK DE
SCRIPTION:
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WO CRIP 'T`I�EI�VATER MAIN
ANY EAFI` w. L1 `PEII'ATCH FOR MAIN
APPLICANT AGREES TO FURNISH THE 1E WN .: ..CSJfT ;q;:Mj {jF30.N3 REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANY:.E ":p4ks'IN"
>.T01" C .1ANTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE A PhICAN.— F ILL;ABIDE BY THE RULES AND REGULATIONS
FOR P ITS AS OUTLINED IN THE TOWN OFfTFT �?�1NI3I;'. I CJT::' RMI1v1ANUAL.
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ISSUED BY DA E> >• ': PEP;D..r INSPECTED BY
12/20/20071:50PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: 700a I CONTRACTOR:
LOCATION:
TYPE OF WORK:
DATE INSP NEEDED: DATE INSP: a
INSPECTED BY: ft
WORK IN
PROGRESS: S.S �� .� C / �� .. - t,-�•�-c�c
AS-BUILT:
INPUT: DATE: /
W/2007 Town of South Windsor INPSECTION REPORT 07
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT 06074
FEE $25.00
Name of Firm Phone No. ..j .� ,.
5
Address of Firm
Location of proposed work > 1 J i i Ll 3 t)/11
Describe fully nature of permit requested_ .11 -1: )L
Starting date_ 12 c>
Approx. time for completion
Call Before You Dig No. 2 oo Traffic Services Control No.
Show sketch of proposed work or furnish
two copies of separate drawing Indicate North This section to be filled out by
Town of South'Windsor
Pavement Cut
No.cuts
Est Size of Perm.Patch(s)
Est PvL Thickness in.
Est Unit Price$
Amt of Deposit$
Total Due$ by
( )Cash( )Check# .
Permanent Patch
� C _
No. Cuts
Size of Patch(s)
Final Billing
$
Amt Due Payee
Amt.Due Town
By
Applicant is responsible for contacting
the Police De t.and C.B.Y.D. Date
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#ITH THIS PET AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR
PERMITS AS INED IN E� OWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
C -- -
Signed:—
Date:..
Title: b c.t.' '�<�
Drivers License#:_ <f7�
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
TOWN OF SOUTH WINDSOR
ENGINEERING DEPARTMENT
ADDRESS
PERMIT N0. SHEET
UTILITIES OF
INSPECTOR TEMP.PATCH DATE
INSPECTOR COMPLETION DATE
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