HomeMy WebLinkAboutStreet Cut Permit 209 Felt Road 1000225 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 11/12/10
GIS ID:32400209 FEE: 25.00
MUNIS APPLICATION# 201001517 EXPIRATION DATE: 11/12/11
APPLICANT LOCATION
NAME: SKIPS SEPTIC ADDRESS 209 FEET ROAD
ADDRESS: 6 NUTMEG DRIVE OWNER LAZEREN PATRICIA A&
P O BOX 29 209 FELTRD
ELLINGTON,CT 06029 SOUTH WINDSOR,CT 06074
PHONE 860-875-2332
WORK DESCRIPTION: CUT INTO ROAD TO CONNECT.TO PUBLIC WATER
APPLICANT AGREES TO FURNISH THE TOWN-OF`SOUTH"WINDSORTHE AMOUNT OF BOND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANY EXPENSES INCURRED BYTHE TOWN FOR MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE APPI ICANT`TS FAMII IAR.WITH AND WILL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF SOUTH WINDSR'S;STREET CUTPI RNIIT MANUAL.
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ISSUED BY 4)ATF INSPECTED INSPECTED BY
11/12/201012:35PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: / ` �' CONTRACTOR: 5 rV
LOCATION: a � ��1,4-
TYPE OF WORK: CSD nn��.�V2
DATE INSP NEEDED: DATE INSP:_// /61 ®® —
INSPECTED BY: i6b
WORK IN
PROGRESS: �,-��+-�-�r �� 1 f� � ,5 G
Cc,;i K e_c4 Ao w klz' /1°lce e
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: DATE:
S/FORMS/TOWN OF SOUTH WINDSOR INSPECTION
-20/0 APPLICATION FOR STREET EXCAVATION PERMIT
Appl. N . TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
1540 SULLIVAN AVENUE Date:
SOUTH WINDSOR, CT 06074
FEE $25.00
Name of Firm Sk rP5 S£ 77c- Phone No. 64,0" 87- - Z 332
Address of Firm R o fox 2 9 ( /V(�2r171£6 P(Z- (Fc-Z- A)677,�j Zip Code
Location of proposed work
Describe fully nature of permit requested C cc-,- 6A11-V �z n, C o/r N,r"C'i
Starting date Approx.time for completion l
Call Before You Dig No. 30 3 ¢o 7 Existing Water Supply: ❑Public Water [Well
Existing Sewage Service: WPublic Sewer ❑ Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY INCREASES IN PATCH AREA,CURB
LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing. Indicate.North Town of South Windsor
No.cuts f
Est.Patch Size(s) sf
Est.Pvt.Thickness in.
Z d 1 Est.Patch Unit Price$ ,;5'®p /sf
Est.Patch Cost$
Est.Curb Replacement ft
Est.Curb Unit Price$. /ft
Est.Curb Cost$
l �P� Est.Traffic Unit Cost$ : /hr
J�fTLVi F—
Est.Traffic Control$
Saks£w Amt.of Deposit$
Total Due$ 1 Z = a
b"a's/ ( )Cash (4heck# 4c6 3
ju
Applicant is responsible for contacting paid By. '5ks P-s -P T iC
the Police Dept.and C.B.Y.D.
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 PFF11 T AtiD THAT 1 AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR
PERMITS AS OU ED IN O N OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: Date: / - -I0
Title: (7rz Driver's License#:
PLEASE ALLOW AT LEAST TWO WORKING DAYS AFTER APPLICATION FOR ISSUANCE OF PERMIT
WORK MAY NOT BEGIN UNTIL A PERMIT HAS BEEN ISSUED
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
Street Excavation Permit 08 REV 10-22-08
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