HomeMy WebLinkAboutStreet Cut Permit 972 Chapel Road 900143 TOWN OF SOUTH WINDSOR CT
PERMIT NUMBER
y„ STREET CUT PERMIT
DATE: 10/29/09 _
GIS ID: 18000972jwmi r
MUNIS APPLICATION# 200901319 � FEE:
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ARATIONDATE: 10/29/00 APPLICAN " ` 3
NAME: QUALITY PAVING C LOCATION
ADDRESS: 194 S.MAIN STREETS ,� Q�'EL ROAD
EAST WINDSOR,CT 8 OES
ARBARA C
EL RD
PHONE 860-523-4182 O DSOR,CT 06074
WORK DESCRIPTION: DRIVk yy f
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APPLICANT AGREES TO FURNISH THE T � X
THE TOWN OF SOUTH WINDSOR FOR ANY C �FPND REQUIRED AND TO REIMBURSE
CONNECTION WITH THIS PERMIT AND THE AT= MAINTENANCE OR REPAIR WORK IN
FOR PERMITS AS OUTLINED IN THE TOWN OF S � S ND LL ABIDE BY THE RULES AND REGULATIONS
MANUAL.
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ISSUED BY v DATE IN PECTED
INSPECTED BY
10/29/200910:01AM ' PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: I®D ( N 3 CONTRACTOR: Q ua,
LOCATION: /
TYPE OF WORK: D f i V (Aj2 "
DATE INSP NEEDED: DATE INSP: / q Ile
INSPECTED BY: Rb
WORK IN
PROGRESS:
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SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: (i
DATE: I ' 2' '(�
W/2007 Town of South Windsor INPSEMON REPORT 07
APPLICATION FOR STREET EXCAVATION PERMIT q ov I.q
goo 9 0) 3 TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT Permit No.
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT 06074
FEE $25.00
Name of Firm_ u.t �Q ,;,� Phone No.
Address.of Firm_.1�
Location of proposed work q 7
Describe fully nature of permit requested
Starting date- 1 s -
Call Before You Dig No.-;0a A 44.0 �� �� Approx.time for completion_
Traffic Services Control No.
6 A I U
Show sketch of proposed work or furnish
two copies of separate drawing Indicate North This section to be filled out by
Town of South'wndsor
Pavement Cut
No.cuts
Est'Size of Perm.PatctXs)
Est Pvt.Thickness in.
— Iv I , Est Unit Price$
Amt of Deposit$
a Total Due$ by
Cash( )Check#
Permanent Patch
No. Cuts
—!o i Size of Patch(s)
Final Billing
Amt.Due Payee
Amy:Due Town
By
Applicant is re s risible for contacti
the Police Dept.and C.B.Y.D.
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. UTLIN D IN THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed:
_ Date: c) Gi
Title: lid
Drivers License M ® 6-3 Li 4-f,-1 3 a
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES