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HomeMy WebLinkAboutConnect yard drain to CB Street Cut Perm 700142 TOWN OF SOUTH WINDSOR, CT -� PERMIT NUMBER STREET CUT PERMIT DATE: 09/12/07 GIS ID: 81600007 f MUNIS APPLICATION# FEE: 200701464 ,:_:<`"' "``' 25.00 kti. R ATIO NDAT E• /1• 0 9 1/08 APPLICANT s:: :.......:. ,R. NAME: LOCATIO H W LE VAC :,, <,... ;:: N REST, . <>.7. >,..: .. S ADDRESS: 49 MASCOLOTT DRIVE O ROAD ' ' OWN-ER SOUTH WINDSOR CT r;: bWARD B&MARGOT A :Q.6.074 >. :<<:< 'DIVE ` J I . S H II'�TD O NE � O R CT 0 60 74 WO RK RK DE SCRIPTION: SC RIP T IO N• Co nne'.�tCB APPLICANT AGREES TO FURNISH THE TCIWN F TH:: THE TOWN OF SOUTH WINDSOR FOR ANY''. iiTbu.ph�TOLITiQ BtIID REQUIRED AND TO REIMBURSE XFENSS;IN;' ` '_ QMINTENANCE OR REPAIR WORK IN CONNECTION WITH THIS PERMIT AND THE P I N AR FI AND WTI, ABIDE BY THE RULES AND REGULATIONS FOR PERMITS AS OUTLINED IN THE TOWN OF 9"W'T T M-SR S S^T`REE_ p MANUAL. f' 0-1 ISSUED BY � DATE INSPECTED INSPECTED BY 9/12/20079:22AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES*** TOWN OF SOUTH WINDSOR INSPECTION REPORT PERMIT NO.: 1117 00)q 0� CONTRACTOR: LOCATION:_ TYPE OF WORK:_ Cc)vi y►zfrZli DATE INSP NEEDED: DATE INSP: 9 1 4f o7 INSPECTED BY: f3�j WORK IN PROGRESS: Cmd ro,-�f �'e�►Id E,c�sl.l.� G `� c3r _klutg °pL�e S 00- 31s; .fit S© -Tv, AS-BUILT: INPUT: C YV\ DATE: W/2007 Town of South Windsor INPSECTION REPORT 07 APPLICATION FOR STREET EXCAVATION PERMIT TOWN OF SOUTH WINDSOR�. PUBLIC WORKS DEPARTMENT Permit No. TOWN HALL 1540 SULLIVAN AVENUE SOUTH WINDSOR, CT 06074 FEE $25.00 Name of Firm _ Address of Firm �' ��� Phone No. Location of proposed work_` 7 Describe fully nature of permit requested Starting date " _ Call Before You Dig No. Approx. time for completion Traffic Services Control No. i Show sketch of proposed work or furnish two copies of separate drawing Indicate North This sectlon to be filled out by Town of South'Windsor Pavement Cut No.cuts Est.Size of Penn.PatctKs) Est.PvL Thickness in. Est.Unit Price$ Amt.of Deposit$ Total Due$ by )Cash( )Check# . L---/ Permanent Patch No. Cuts Size of Patch(s) Final Billing Amt.Due Payee � p P-Prr Amt.Due Town By Applicant is responsible for contacting the Police Dept.and C.B.Y.D. Date 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 AS OUTLINED IN THE TOWN OF SOUTH WINOSOR'S STREET CUT PERMIT MANUAL. Signed: Date: Title: Driver's License M PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES