HomeMy WebLinkAboutStreet Cut Permit 11 Pheasant Way 1000163 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
mia 0-
DATE: 08/12/10 _
GIS ID: 71100011 - FEE: 25.00
MUNIS APPLICATION# 201001044Af oir
= RATION DATE: 08/12/11
APPLICAN - XLOCATION
NAME: M&S PAVING ANDS PHEANT WAY
ADDRESS: 435 BUCKLAND RO - I DONALD J & DIANE L
SOUTH WINDSOR, 4 :j HE ANT WAY
'`` = Y DSOR,CT 06074
PHONE 860-648-1915 ". � � -
WORK DESCRIPTION: DRIVE "
APPLICANT AGREES TO FURNISH THE T F �, - _ F ND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANY CU H. AINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE 1 1 YND L ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF SC TE (UT - IT MANUAL.
ISSUED BY DATE INSPECTED INSPECTED BY
8/12/201012:06PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: 060 6VLaq
�(�� CONTRACTOR:
LOCATION: l h�qs7ceif
TYPE OF WORK: Dr 1 Ue wo
DATE INSP NEEDED: DATE INSP:
INSPECTED BY: 4d
WORK IN
PROGRESS: ar4ij
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
� fINPUT: DATE:
S/FORMS/TOWN OF SOUTH WINDSOR INSPECTION
APPLICATION FOR STREET EXCAVATION PERMIT q/(p
TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS 1DEPARTMENT
TOWN HALL
1640 SULLIVAN AVENUE
SOUTH WINDSOR,CT 06074
c n FEE $25.00
Name of Firm S ,f 1/1 I (L Phone No. 'QLW (0,w- 19
Address of firm 1 IT
Location of proposed wo
/I
Describe fully nature of permit requested
Starting date lohoApprox.time for completion
Call Before You Dig No. Traffic Services Control No.
Show sketch of proposed ork or fbM18nThis section to be filled out by
two copies of separated ng Indicate North Town of South Windsor
Pavement Cut
No.cuts
Est.Size of Perm.Patch(s)
Est.Pvt.Thickness in.
Est.Unit Price$
0{ Amt.of Deposit
Total Due$ by
( )Cash( )Check#
Permanent Patch
No. Guts
Size of Patch(s)
4
Final Billing
Amt.Due Payee
Amt.Due Town
By
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 OUTLINEVE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: ^ `J11c)Date:
Title: Driver's License#.
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES