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HomeMy WebLinkAboutDriveway Street Cut Permits 15 Welles La 800063 PERMIT NUMBER TOWN OF SOUTH W I N D S O R, CT STREET CUT PERMI DATE: 05/08/08 Z' GIS ID:9290 0015 M UN I S AP P L I C A T I O N 20 0800630 0 8 0 0 6 3 0 FEE: 25.00 TIRATION DATE: APPLICANT 05/08/09 NAME: QUALITY PAV IN ADDRESS 11>OCAT 4 S.MAIN STREET ADDES 15 WEB LEA LANE ION EAST WINDSOR,CT 0608$ �WNR L HENI)ERSON&KATHY S PHONE :::,;:.....:::::: :::: .> '':: 5<;< L :ESL 860-523-4182 ANE WIh1DSOR, CT 06074 WORK DESCRIPTION: DRIVE WA Y APPLICANT AGREES TO FURNISH THE TOWN THE TOWN OF SOUTH WINDSOR FOR ANY E ©l IID >3R> 0 f OF:BOND REQUIRED AND TO REIMBURSE CONNECTION WITH THIS PERMIT AND THE A " URSE INCUBI: ] > # :F1JWN;I;ORMXINTENA FOR PERMITS AS OUTLINED IN THE TOWN OF [ 'I _ A, : NCE OR REPAIR WORK IN MIS .AND WILL ABIDE BY THE RULES AND REGULATIONS IN1SIt STREETLTT PE1IT MANUAL. C llu { ISSUED BY DATE'IN,PELTED`5/8/200812:01 PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES*** INSPECTED BY TOWN OF SOUTH WINDSOR INSPECTION REPORT PERMIT NO.: �;C?t� >t CONTRACTOR: LOCATION:_ i S TYPE OF WORK: DATE INSP NEEDED: DATE INSP: e i , o INSPECTED BY: 6D WORK IN PROGRESS: AS-BUILT: INPUT: � � DATE:_ L' �� ' L? y W/2007 Town of South Windsor INPSECTION REPORT 07 APPLICATION FOR STREET EXCAVATION PERMIT Ee3 TOWN OF SOUTH WINDSOR Permit No. PUBLIC WORKS DEPARTMENT TOWN HALL 1540 SULLIVAN AVENUE SOUTH WINDSOR, CT 06074 FEE $25.00 Name of Firm Address of Firm Phone No. 2 Location of proposed work / Describe fully nature of permit requested Starting date_ Approx.time for completion_- Call Before You Dig No._ �t; P �(n c� O�( Traffic Services Control No. Show sketch of proposed work or furnish two copies of separate drawing Indicate North This section to be filled out by Town of South'wndsor Pavement Cut V No.cuts Est.Size of Perm.Patch(s) I Est.Pvt.Thickness in. l � r . 5 Est.Unit Price$ Arnt of Deposit$ Total Due$ by i 1 ( )Cash( )Check# ( Permanent Patch S 7 r No. Cuts Size of Patch(s) Final Billing Amt.Due Payee t,Y ! AnA Due Town By Applicant is responsible for contacting the Police Dept.and C.B.Y.D. Data 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 WITH THIS PERMIT AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR PERMITS A UTL IN THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL. Signed: 17 Date:_ Title: Driver's License#: fj�, i -z, --I-( q e PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES