HomeMy WebLinkAboutDrain Layers Permit 505 Pleasant Valley (2) ` e TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 3682 Contra�: 'a `t� f3D<f: YpAVING CO.
Location 0505 PLEASANT VALLEY
Aciftres q 94 pQAIN' ::STREET
Type Work DRIVEWAY :t
:% EAST [3TNDOR •T, 06088
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Permit No. 3682 Town of South Windsor, CT f
Date 04/23/2004
Street Excavation Permit
Expiration D 3 200 � '
Date 04/2 / 5 •�'' �:`�
Descrip: CK 3652 2 PERMITS s.
Applicant
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Name QUALITY PAVING CO- fY i PMSANt§'.VA1BEY>
Addr. 194 S. MAIN STREET
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EAST WINDSOR C dAPA
Phone _
(860)523 4182
Applicant agrees to 'f rYiisA.' hefTogzn q Sgt#�111 Windsor fkte amount of bond
required and to reidib1.Xx:se`,.� e._` o�#a >< r i i '�;fiox far`:,.AnY
`e ises
p. .
incurred by the Town for,ma11, y4 6, �r,�,.�pair ..:ui��� �� ����nectian with this
permit and that appl cait," h.e r
:"": € ><.: .Y rules and
regulations for permiCs as. yt. ��.}4�cf'..,, ''" .° WU.0:� 5`oki�k� W nds�r's Street
Cut Permit Manual.
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PERMIT TO'°4 E, X1 PT.. C)'I:':..>J&1'$.'�° tt+, `, 'ALL.`";TI.ME��>;>'
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Issued y
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Date Completed ----------------- Inspected By Z ' ��
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
l 1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm ��1` ON Phone No.
Address of Firm o
_
Location of proposed work .r�
e
Describe fully nature of permit r uested
Starting date v Approx.time for completion 1114
-AU
Call Before You Dig No. Traffic Services Control No.
Show sketch of proposed work or furnish To 42 filled out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North Prop.size of cut
. No.cuts
Amt.of Deposit$ by
F. ()Cash()Check#
Cut size after Perm.Patch
No. Cuts
Final Billing$
Amt. Due Payee$
Amt. Due Town$
Applicant is responsible for contacting by date
the Police Dept.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 WINDS R'S STREET CUT PERMIT MANUAL.
Signed: Date:
Title:
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc