HomeMy WebLinkAboutDriveway Street Cut Permit 350 Slater St Peer' 61t No. 3468 Town of South Windsor, CT
Date- 04/28/2003
Street Excavation Permit
Expiration Date 04/27/2004
Descrip:
Applicant Location
Name BLUE DIAMOND PAVINGSi,AT4 ;5TREET
Addr. 1064 EAST ST NORTH ,
SUFFIELD, CT 06078 'fype �f ,Wo0rk ORIVEWAY
Phone (800) 728-4644
Applicant agrees to fuFr7ieh; the' Tc w �f South Wind or the amount of bond
required and to reimburse ;the Totirn of h W $I)f .f¢r any expenses
incurred by the Town For rnt enaG fir; 0pair .w { ire connection with this
permit and that app l i anir s ;f am tip 'z n4 �i.! I .,a�i de by the ru l es and
regulations for permits 'Zia, dUtl10�� �n ;tie "Toqh*,,. ,,South Windsor' s Street
Cut Permit Manual .
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* * PERMIT TO BE KEPT 04,Jp$ S,IT A7 ALL TIMES.
Issued by ->11 a�-�e —_
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 3468 Contractor BLUE DIAMOND PAVING INC
Location 0350 SLATER STREET Address 1064 EAST ST NORTH
Type Work DRIVEWAY P.O. BOX 273
SUFFIELD, CT 06078
<. Phone; No�„ (.800 )728-4644
Q, te4ns !/ 3
Date Ins Needed
Time Insp Needed 1 ime Inso
Inspected By
Work i n Progress ;fib
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Input C ►n� Date NL03
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSO'R, CT
FEE $25.00
Name of Firrry c /4/n6 0,01,11 Phone No.8 60 7�f ' Y(lo Vfl
Address of Firm •O• t ca �4 / 6taisae
Location of proposed work cater AM 6n, . hLLIrosd
cT-
Describe fully nature of permit requested c o(r, i-CAQ rce r
Starting date (YS Z Approx.time for completion
Call Before You ig Non7 �/70�/o)C\ Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North Prop. size of cut
No. cuts
a'
y � Amt. of Deposit$ 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:
Title D.L.#:
PERMIT SHALL BE KEPT ON]OBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc