HomeMy WebLinkAboutDriveway Street Cut Permit 13 Ravine Roa > TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 3520 Cont-ractor C`t?STOM .>PAVING
> Location 0013 RAVINE ROAD f �� Address JOIN F .:JURGE.LAS
Type Work DRIVEWAY ;P. O BOX 178.
SOUTH'WINDS'OR CT<:,06074
phone. No (860)5`28-2684
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Date Insp Needed _ gate
Time Insp Needed ............ -- ;TiMe Insp.
Inspected By
Work in Progress + J i.^- ._�— � /R S - L"
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Input _�1� ,Date �iT
> Permit No. 3520 Town of South Windsor, CT
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Date 06/06/2003 Street Excavation Permit
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Expiration Date 06/05/2004
Descrip:
Applicant.:. Location
Name CUSTOM PAVING 0Q1.3.;>,RAVINE .ROAD
Addr. JOHN F JURGELAS .
SOUTH WINDSOR'CT Q6.074 Type 01'Work :ARIVEWAY
Phone (860)528-2684
Applicant agrees to 'furnish the `own of South Windsor the-4 ount of bond
required and to reimburse the Tawn of Sot3t11 Tx?idsor for any expenses
incurred by the Town $or maiiitenance or repair"work 7n connec 'ion with this
permit and that applicant is;familiar w3Tx. ad.will abide by:;the rules and
regulations for permits as outlined kn the Town of South Windsor s Street
Cut Permit Manual.
* * PERMIT TO BE ::KEPT ON JOB= SITE AT ALL TIMES.*
Issued by -------- --r1pLC1_. -Title--
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Date Completed __ Inspected By e ' --
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3 5 J'O
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm ! a t� -Phone No.- 25-�2s
Address of Firm / k/1
Location of proposed work / _A ,q V/A4 g
t
Describe fully nature of permit requested r v
Starting date y V `7 Approx.time for completion
Call Before You Dig No. .�or'O3 -Rle traffic Services Control No. 2�
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North Prop. size of cut
C� No. cuts
Amt. of Deposit$ by
( )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 WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: Date: /r7 A Y �y
Title: , D.L.#: D 3/
PERMIT SHALL BE KEPT ON]OBSTTE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc