HomeMy WebLinkAboutStreet Cut Permit 123 Hayes Road 1000058 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PER
MIT
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DATE: 04/13/10 � , �3
GIS ID:40200123 IL
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FEE: 25.00
MUNIS APPLICATION# 201000380 s = EATION DATE: 04/13/11
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APPLICANT
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NAME: M&S PAVING AND S ? Ti,I5 I ' S ROAD
ADDRESS: 435 BUCKLAND RObf HYOBERT A&KIMBERLY M
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SOUTH WINDSOR,C b�fl'
_ _ �3ll QYtS ROAD
HVTNDSOR,CT 06074
PHONE 860-648-1915 % �JT
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WORK DESCRIPTION: REMOV�ANbI �
APPLICANT AGREES TO FURNISH THE T01W REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANY GURKRE'- BY -
�3U MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE AP JCA&-3 r ILL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF SO T P- iJ RMIT MANUAL.
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ISSUED B DATE INS ECTED INSPECTED BY
4/1 3/20 1 0 2:05PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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INSPECTED BY:
WORK IN
PROGRESS: etc
SEPTIC TANK PUMPED, SMASHED, FILLED - - WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: DATE:
W/2007 Town of South Windsor INPSECTION REPORT 07
-
APPLICATION FOR SIREET�EXCAVATION P
-G.
ERMIT I��-777
TOWN'OF SOUTH 1NINDSOR
Permit'No
Q`. 46 PUBLIC WORKS DEPARTMENT `
TOW, HALL,
1540 SU M, AN AVENUE
SOUTH WIN SORXT_:06Q74 .
FEE $25.00
Name of Firm . ` ��,I_In �s/tdQ Phone No.
Address of Firm !I " m jv
Location of proposed work -
Describe fully nature-
ature of Dormit r nested
�9. P��fTT � ✓Cif
660r`
Starting date
Approx time for'.completion
Call Before'You Dig No: 1 ]�lX7o� Traffic Seiv�ces Con No.
Show sketch-of proposed work or furnish
two copies of separate drawing Incucate:Nohh This section to be filled of by
Town of South`Windsor
_.
Pavement Cut
as =3
No..cuts
Est.Siie of-Penn.Patc�(s) -
P/U Est.Pvt Thk�cness in:
- :Est.Unit'Price$< -
Amt.of Deposit$
y
Total Due$ Eb
Y.
sh(,ICM&#=2� L
Pem�anent Patch
No Cuts
Size"of Patch(s}
Final Billing
Amt.Due,Payee
Aml Due Town
ly,
Applicant is responsible for contacting Date
the Police De t.and"CB.Y.D. 77777777
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AGREE TO FURNISH TO THE.TOWN OFSOUTH WINDSOR -HE-AMOUNT-OP,BOND REQUIRED"AND TO,REIMBURSE;THE'TOWN,OF SOUTH WINDSOR,FOR ANY EXPENSES INCURRED.BY THE.'TOWN FOR MAINTENANCE_OR'_REPAIR WDRK IN.CERMITS .S OU LI THIS PERMIT AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES,AND REGULATIONS;FOR
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PERMITS AS OUTLINED IN"THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL
signed: Date:
Title: Drivers License#:
PERMIT,
SHALL BE KEPT ON JOBSITE AT ALL TIMES
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435 Buckland Road 6 Springside Avenue
So. Windsor, CT 06074 Danbury, CT 06810
Ph: (860) 648-1915 gob Ph: (203) 790-9727
Fax: (860) 648-4602 pQd� � Q ° � Fax: (203) 794-9172
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