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HomeMy WebLinkAboutStreet Cut Permit 195 Dogwood Lane 1000203 TOWN OF SOUTH WINDSOR, CT PERMIT NUMBER STREET CUT PERMIT DATE: 09/23/10 GIS ID:28500195 ' MUNIS APPLICATION# 201001289 - /may FEE: 25.00 s IRATION DATE: 09/23/11 ti APPLICANT F '��j LOCATION NAME: M&S PAVING AND S A, IN K401j95 DOGWOOD LANE ADDRESS: 435 BUCKLAND RO f �' IOHN M&ELLEN B SOUTH WINDSOR,(fqf 4 s C WOOD LANE � � 7 V INDSOR,CT 06074 PHONE 860-648-1915 is WORK DESCRIPTION: EXCA �I S V _E1IT ONE FOOT WS y y U w APPLICANT AGREES TO FURNISH THE I` V��R (STfI AND REQUIRED AND TO REIMBURSE THE TOWN OF SOUTH WINDSOR FOR ANI� �ECU T © 4GIAINTENANCE OR REPAIR WORK IN CONNECTION WITH THIS PERMIT AND THE�P =I W L ABIDE BY THE RULES AND REGULATIONS FOR PERMITS AS OUTLINED IN THE TOWN OF1SR1j�T- IT MANUAL. ISSUED BY DA E INSPECTED INSPECTED BY 9/23/2010 11:25 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES*** ----------- Ar � s I Ar Iff 1Ll g y 0 � � ' �- p �� j INN- 1 e G % _ t- Ao � � �y j % TOWN OF SOUTH WINDSOR INSPECTION REPORT PERMIT NO.: /00000 CONTRACTOR: M 4- S �QV JrI�l LOCATION: 19 5 Do geA)o d TYPE OF WORK: T)r-\ve vjcr L4 DATE INSP NEEDED: DATE INSP: INSPECTED BY: r3 l) WORK IN PROGRESS: �,,,.c SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO AS-BUILT: INPUT: _ DATE:E_a,�I - 1 I S/FORMS/TOWN OF SOUTH WINDSOR INSPECTION APPLICATION FOR STREET EXCAVATION PERMIT L*? TOWN OF SOUTH WINDSOR Permit No. PUBLIC WORKS DEPARTMENT TOWN HALL 1540 SULLIVAN.AVENUE SOUTH WINDSOR,CT 06074 t n FEE $25.00 Name of Firm 4 fl✓l()C �i-dn phone No, Address of Firm ) Ird � CT Location of:'proposedd k D Describe fully riatUre of permit requested Starting date — Approx.tim for completfon Call Before You Dig No. (� Traffic Services Control No. Show sketch of proposed work or famish two copies of separate drawing Indicate North This section to be filled out by Town of South Windsor Pavement Cut No.cuts 0 Est.Size of Perm.Patch(s) Est.Pvt.Thickness In. Est:Unit Price$ Amt.of Deposit$ Total Due by ( )Cash( )Check# Permanent Patch No. Cuts Size of Patch(s) Final Billing Amt.Due Payee Amt.Due Town Sy Applicant Is responsible for contacting Date the Police De t.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 PERMIT AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR PERMITS AS OUTLINED IN THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL. Signed: Date: Title: Driver's License#: PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES