HomeMy WebLinkAboutWater, sewer, and drain connections Stre F SOUTH WI
pEWgIT RP�IIT NUMBER TOWN O N D S O R, CT
STREET CUT PERMIT
DATE: 07/18/07
GIS ID: 71100120
MUNIS APP .r.�.:
LICATION# 200701124 FEE:
":. 25.00
ON DATE:
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APPLICANT'
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SCRIPTION:
S C RIP T I O N:
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NO DIS .: NECTfONS
APPLICAN
T AGREES TO FURNISH `THE TQWN Olss(�U�:::<.;':<;."';:":.,..:
THE TOWN OF SOUT ? LYIO.
H WINDSOR FOR AN`�'.E'�.;'."•:Eij'�:�c�,: , '< � " `� �' ;; ;T OF BQ�D REQUIRED AND TO REIMBURSE
CONNECTION WITH THIS PERMIT AND THE;: „ TINTENANCE OR REPAIR WORK IN
4 '` WI ` NI 'WIIT.I ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN O1 ,Oi7F1; lINDS :
a 'LTT:PERMIT MANUAL.
ISSUED BY DA' -
BED INSPECTED BY
7/18/200712:29PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT*NO.: `7—()// / CONTRACTOR:_ ,Utz;-L-ele
LOCATION: O O�►�i � �,/ � ADDRESS:
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TYPE OF WORK: L.A)0 Pu1�t. IL
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DATE INSP NEEDED: DATE INSP: <- 3 0�
INSPECTED BY: 9
WORK IN
PROGRESS:
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INPUT:___ DATE:
y APPLICATION FOR STREET EXCAVATION PERMIT & I
TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT 06074
FEE $25.00
Name of Firm_ 2� ��- U I +i L L Phone Noy d(,n —87 Z-2.3 5 o
Address of Firm_ 3 P i ti d�JftZ L,� �p
Location of proposed work L2u
pescribe fully nature of permit requested c,y Z, w s to i a
Starting date_ 7- 2 3 -o 7
Approx.time for completion_ t w CE k
Call Before You Dig No. Z Zq o 18 Traffic Services Control No.
Show sketch of proposed work or furnish
two copies of separate drawing Indicate North This section to be filled out by
Town of South'Windsor
Pavement Cut
No.cuts
Est.'Size of Perin.Patch(s)
Est.Pvt.Thickness in.
Est.Unit Price$
Amt.of Deposit$
• o
o
Total Due$ by
Ott ' G ( )Cash( )Check#
Permanent Patch
No. Cuts
Z
Size of Patch(s)
J&S
Final Billing
Amt.Due Payee
�tAC� `� $
Amt. Due Town
By
_ Applicant is res nsibie for contactin
the Police De t.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
CONNET
ITH THIS RMIT AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR
PERMITLINNED I E TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: r
Date:
Title: 0 le
Driver's License ff: z z z 6;3
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES