HomeMy WebLinkAboutExcavate for water main break Street Cut 800210 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER
STREET CUT PERMIT
DATE: 12/31/08
GIS ID: 73800012 : x
MUNIS APPLICAT y>' :;'r FEE:
ION# 200802008 .00
.IRATION DATE:
: .. 12/31/09
APPLICAN »'T >:
<:r
N ,' :: <~ .. LOCATION
AME: CONNECTICUT W f I ;G�. �Y`X: ...6£...
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ADDRESS: 25 •�<>;:a; y>;"'; ';L�1R DRIVE
NORTH ROAD � ,< ;<:�''• ` ";3. ;
EAST WINDSOR, G.T. O:6O8 ;, p NSEIA SALVATORE P&CAROL L
F" Pc� LR DRIVE
PHONE 860-623-3355 y OATH-41NDSOR,CT 06074
WORK DESCRIPTION: &WA1 .�WWA ,x
ATE
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APPLICANT AGREES TO FURNISH THE 7*. V�•OF``:''°<..�,: ';;�_' R"' ` ;.A.W ,6tNT:, ,�F BOND REQUIRED AND TO REIMBURSE
SQUI�:1� C It
THE TOWN OF SOUTH WINDSOR FOR ANI E *E 1SE 1VC U ':'7 E;IQ ,F6R MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE tpI31{CNT'' >> I: ITEI„r�ND„(ILL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF hLT°iI:jV) r R}S.STtyTPIT MANUAL.
ISSUED BY DATE INSPECTED ^�
INSPECTED BY
12/31/200811:54AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: co CONTRACTOR: C_ WC-
LOCATION: 1
TYPE OF WORK: C 440_ ')'} a I 6/v/7a
DATE INSP NEEDED:
DATE INSP:
INSPECTED BY: 9 D
WORK IN
PROGRESS: -Vx `"rvN-1ss ; Y fi}- t
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AS-BUILT:
INPUT: r AN DATE:_
W/2007 Town of South Windsor INPSECfION REPORT 07
APPLICATION FOR STREET EXCAVATION. PERMIT � 00�/ o
TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORDS DEPARTMENT
TOWN HALL
1640 SULLIVAN AVENUE
SOUTH WINOSOR,CT 06074
FEE $25.00
'Name of Firm—L.T. 't' Phone No. - n 3 31
Address of Firm 5 oiC"N s
Location of proposed work_- 2 VaeLLIt S ,
Deco ft fully nature of permit re
P quested X�JD 1f 14Tr �b 2 G.�ATE µ�,a� �,� •
Starting date 2 22 Approx.time for completlo
Call Before You Dig No o Traffic Services Control No
Show sketch of Proposed woic or furnish
two copies of separate dmwft Indioate North This lemon.12 m2d gutty
TOM of 9outh'Wlnd�e�
Pavement Cut
No.cuts
Bat.Sere of Perm.Patch(s)
, I�OPLA2 SLC. ,
Est.Pvt.Thkkneea Itl,
• � Est Unit Prim
e
Amt.of Depoek$
ToW Due$ by
( )Cash( )Check# _
r 'Permment Patch
4` A�<Cv4 OF 2 No. Cuts
�-r— 9AC.4 Wltl&l , sloe of PO
WN°)
!, I Final BMing
g�rbv,r AmL Due Payee
Amt.Due Town
By
llCant is re Donsible for cointaptIng
the v Ice act,an .B,Y.D,
I AOREE 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 REOULATIONS FOR
PERMITS INED IN E TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL,
Signed- /
Date:_ /e2113yo.
Title! Driver's License#s
PERMIT SHALL Be KEPT ON JOBSITE AT ALL TIMES
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