HomeMy WebLinkAboutRemove and replace driveway Street Cut P (3) 800155
,PEn TNUMBER TOWN OF SOUTH WINDSOR, CT
DATE: 09/04/08 STREET CUT PERMIT
GIS ID: : .:
774001.42
MUNIS APPL # 20080
ICATION ,
1377
F,.. EE:
25
.00 0 0
�:,<• TION DA
TE:
04/09
APPLICAN'T' t,
NAME:
PAVING
.� •LOCATION
ADDRESS: 435 BUCKLAND ROAD 4 RQSEMARY LANE
SOUTH WINDSOR,(T'1f60'1 ' rY r r a 3 �s ' I��KAN bOROTHy J
9} Y} ;ri' _42 1SE1XfARY LA
PHONE 860-648-1915 r s f 'SOUTH W SOR,CT 06074
WORK DESCRIPTION: t k ?
REMOTE A1tiTY �I.A�I�
rr,
APPLICANT AGREES TO FURNISH THE TW° `OF 0 `.
THE TOWN OF SOUTH WINDSOR FOR ANYko
XFE�T 1 S i 'CII TOW FOR 1V IN
IAINTENQANCED AND TO OR REPAIR WMBURSE
CONNECTION WITH THIS PERMIT AND THE APPLi°C
T '� 'I'�R�VI PFI;kND VI L ABIDE BY THE RULES AND REGULATIONS
ATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF SCbI1TAAlIS
` TR .CEJT RE-9-MIT MANUAL.
ISSUED BY 1
DATE SPECTED
9/4/200812:04PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES*** INSPECTED BY
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: b 1 S.S
CONTRACTOR: M `V�S
LOCATION: 1 y ��
TYPE OF WORK:_��
- --- --- DATE INSP NEEDED: DATE INSP: 6 Z�l 0 8
INSPECTED BY: 13.E
WORK IN
PROGRESS: r; � : Celt
AS-BUILT:
INPUT: C DATE: ) Q-.3/ • 0 9
W/2007 Town of South Windsor INPSEMON REPORT 07
APPLICATION FOR STREEET EXCAVATION PERMt:T �'
FSOUTH INDR mt NTOWN O o:ert .
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540;SULLIVAN-AVENUE
SOUTH WIND 4 06074
c-.
Na �-ME
of Firm
- PhoneNo;_
Address
hu
l�
Location of proposed worK. .I �srr),q-, y (� E
Describe fully nature of per: requested_
Starting date �K`�•Q
Approx.time for completion aD S
Call Before You Dig No. 00f� r Traffic Services Control No.
Show sketctf of,propose&work or furnish This section fo ire filled out by
two Copies of separate drawing Indicate Nortfi
Town of South Windsor
Pavement`Cut
„7 X vim! No..cuts
G� X 7 Est Size.of Perm:,Patch(s).
4 x 3 ~ Est PvL Tlilckness in.
w p�-1G Est Unit Price.$
Ant of Depose#.$
Total Due$ by
( ;)Cash( )Cbeck#
Pem�anent Patch`
No. Cuts
Size•of Pateh(s)
Finae Balleng
Am%'Duell?
Amf Due Town,
By
ApplicantIs responsible for confac#eng Date
the P61ice',beiit and C:B_Y D.
1,AGREE TO FURNISH TO THE TOWN 77
OF SOUTH 1NIND$OR THE AMOUNT'OF BOND REQUIRED AND TO rRE1MBURSE THE .TOWN OF SOUTH WINDSOR;FOR ANY EXPENSES.aNCURRED BY THE T-OIIVN FOR MAIM€NANCE OR.REPAIR WORK`7N�
CQNNf=CTION 17VITH THIS PERMIT AND THAT'1 AM:FAFAILIAR WITHI AND WILL ABIDE BY THE RULES`AND REGULATIONS-.FOR;, 'PERMlTS;AS. UTLI D`IN THE TOWN OF SOUTH WINDSOR'S STREET CUT PER MANUAL.
Signed Date: • _
Title: . ; Driver's License#:
PERMIT SHALL BE KEPT O.N J.OBSITE;AT ALL TIMES