HomeMy WebLinkAboutStreet Cut Permits 19 Simcka Drive (2) 1300102 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PUBLIC UTILITY
DATE: 05/16/2013
GIS ID: 82800019 _
MUNIS APPLICATION# 201300648 !� FEE: 0.00
kPIRATION DATE:
APPLICANT
NAME: METROPOLITAN DIS�'RI� LOCATION
T �
ADDRESS: 125 MAXIM ROAD �'s�DDRES t9 SVM&KA DRIVE
% IEI *RCK ON CHARLES 0 SR&JENNIFER 0
HARTFORD, CT 061 F-4 =
�9is DRIVE
PHONE INDSOR, CT 06074
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WORK DESCRIPTION: REPAI 'lol rvIP 5
APPLICANT AGREES TO FURNISH THE'IV_OF SOUTIJ �g
THE TOWN OF SOUTH WINDSOR FOR ANEP SI €CAMT FEND REQUIRED AND TO REIMBURSE
� 3��H-FWNf?RIAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND T146 P CAI�TT IS��W A 3 WJ 0 ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTL/�I�aNED IN�nTHE TOWN OF U TJR WI I Rs�s T1 PE IT MANUAL.
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ISSUED BY DATEINSPCTED INSPECTED BY
5/16/2013 11:08 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: 13 On I ®� CONTRACTOR: (+'l
LOCATION:_%__
TYPE OF WORK: ,
DATE INSP NEEDED: DATE
INSPECTED BY: 6
WORK IN
PROGRESS:
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT.
INPUT:_ DATE:_ ' I -�
S/FORMS/TOWN OF SOUTH WINDSOR INSPECTION
THE METROPOLITAN DISTRICT - PAVEMENT CUT DATE
BILL JOB DYES INO
ID&.-TOWN r/
A STATE HIGHWAY 0 YES YNO
SKETCH SHOWING LOCATION AND SIZE OF UTS AND CUT MADE IN
CROSS SWTION OF PAVEMENT
VSTREET XBITUM.--,,19"' 0 CONC. 0 PREMIX
0 SIDEWALK OBITUM.-" 0 CONC.. Ill FLAG
OCURB DBITUM.-' 0 CONC.- 0 STONE
El DRIVEWAY 0 BITUM._" 0 CONC.
0 GRASS LOAM&SEED NEEDED 0 YES ;a O
REASON FOR CUT.
DEPTH OF EXCAVATION:
o
NUMBER OF CUTS:
DATE OF FIRST CUT.
IS JOB COMPLETED: /YES ONO
FOREMAN:
Lu
of REPLACEMENT PAVEMENT CONTRACT NO.:
BITUMINOUS D CONCRETE 0 PREMIX El
DATE COMPLETED:
ACCOUNT NUMBER:-
CALCULATIOVINS
NO,
QFQU ITEM# ff-F-M-# IIEM ITEM
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PRFZ-QQ 14ADn 13 nnoizc%�* PAVING INSPECTOR