HomeMy WebLinkAboutStreet Cut Permit 17 Dogwood Lane 1000099 TOWN OF . SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 06/08/10
GIS ID:28500017 =- FEE: 25.00
MUNIS APPLICATION# 201000690 or$7
� �� ��RATION DATE: 06/08/11
APPLICAN LOCATION
NAME: BOUTIN&SONS 1OGOOD LANE
ADDRESS: 121 WINDSORVILLE2I
F A.� I E A&SANDRA A
BROAD BROOK CT16 6
3 3GOOD LANE
= � JV-fINDSOR,CT 06074
PHONE 860-623-2526 - -'
4
WORK DESCRIPTION: DRIV -
� 5 ;
APPLICANT AGREES TO FURNISH THE TF ZS 8 _
THE TOWN OF SOUTH WINDSOR FOR AN � ��REQUIRED AND TO REIMBURSE
, IIAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE � � l�ND", L ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF SO �� IT MANUAL.
ISSUED BY DATE INSPECTED
INSPECTED BY
6/8/20109:08AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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APPLICATION�F OR STREET EXCAVATION PERMIT -
ON OF SOUTH WINDSOR
PUBLIC- WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN.AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm Boutin & Sons Cons t. Co. Phone No. 623-2526
Address of Firm 121 Windsorville Road roa rook, Conn 06016
Location of proposed work 17 Dogs mod T anP
Describe fully nature of permit requested Str.`i p paxisting dr-'i or-y—d-d-gravel as needed, svade�r9�
and t2 VP_ •
Starting date Approx.time for completion
Call before you dig no. 20102?,01252 Traffic Services Control No.
Show sketch of proposed work or furnish TO be filled out by Town Of So. Windsor
two copies of separate drawing Pavement Cut
Indicate North / Prop.size of cut
No.cuts
/ Amt.of Deposit S by
O Cash O Check#
Cut size after Perm. Patch
No.Cuts
Final Billing S
Amt. Due Payee S
Amt.Due Town S
Applicant is responsible for con cting
the Police Dept.and C.S.Y.D. by date
1 AGREE TO FURNISH TO THE TOWN OF SOUTH WINDSOR THE AMOUNT OF BOND REQUIRED AND TO REIMBURSE THE TOWN OF
SOUTH WJNDSOR FOR ANY EXPENSES INCURRED BY THE TOWN FOR MAINTENANCE OR REPAIR WORK IN CONNECTION WITH THIS
PERMIT AND THAT 1 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: 14wDate:
Title: D.L.#
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
TOWN OF SOUTH WINDSOR INSPECTION REPORT
:PERMIT NO v 9 CONTRACTOR:
LOCATION: Q
TYPE OF WORK: 6/
DATE INSP NEEDED: DATE INSP: �
INSPECTED BY:
WORK IN
PROGRESS:
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: Gam- DATE:
W12007 Town of South Windsor INPSECIION REPORT 07