HomeMy WebLinkAboutStreet Cut Permit 7 Debbie Drive 1000164 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER
_ STREET CUT PERMIT
DATE: 08/12/10
GIS ID: 26700007
MUNIS APPLICATION# 201001045 - � FEE: 25.00
_ RATION DATE: 08/12/11
APPLICAN LOCATION
NAME: M&S PAVING ANDS EBB- DRIVE
ADDRESS: 435 BUCKLAND RO
SOUTH WINDSOR, - U DOUGLAS R. & DONNA L
VL B= DRIVE
Vfk PHONE 860-648-1915 b _ ;
SOR,CT 06074
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WORK DESCRIPTION: DRIV Y
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APPLICANT AGREES TO FURNISH THE T FPI £F ND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANY ES C AINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE
FOR PERMITS AS OUTLINED IN THE TOWN OF S � ITL ABIDE BY THE RULES AND REGULATIONS�- MANUAL.
App /P , "
ISSUED BY DATE INSPECTED
..INSPECTED BY
8/12/201012:12PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
__.... ------------....- ---------...._..----
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: CONTRACTOR: Yfi of's Ct I�
LOCATION:
TYPE OF WORK: -1)r 1 V e Wag
DATE INSP NEEDED: DATE INSP: i Iq )
INSPECTED BY: _D
WORK IN
PROGRESS:
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: DATE:
S/FORMS/TOWN OF SOUTH WINDSOR INSPECTION
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF:SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
TOWN HALL
1640 SULLIVAN AVENUE
SOUTH WINDSOR,CT 06074
FEE $25.00 C7�
Name of Firm rn-° S r �/2 rp.-L,(1 Phone No.
Address of Firm 1 ti1L l tl
Location of pmDosed work
Describe fully nature of permit requested ,Q IAQ� /] ✓rt-:.�)
Starting date I Approx.time for completion.
Cali Before You Dig o. �rJ)l) �. Traffic Services Control No:
Show sketch of proposed work or fumish This sectioion to be filled out by
two copies of separate drawing Indicate North Town South Wind so
0 Pavement Cut
No.cuts
Est.Size of Perm.Patch(s)
Est.Pvt:Thickness in.
Est:Unit Price$
Amt.of[deposit
Total Due$ by
E )Cash{ 1 Check#
Permanent Patch
N,o. Cuts
Size of Patch(s)
Final Billing
Amt.Due Payee
Amt.Due Town
By
Applicant is responsible for contacting Date
the Police De,t.and C.S.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 PERMIT AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR
PERMITS A OUTLINED TH TIOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: /
Date-
Title:— 31 Drivers License#;
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES