HomeMy WebLinkAboutDriveway Street Cut Permit 411 Slater St Permit No. 3523 Town of South Windsor, CT
Date 06/06/2003 Street Excavation Permit
Expiration Date 06/05/2004
Descrip:
Applicant Location
Name CUSTOM PAVING 9411 SLATER STREET
Addr. JOHN F JURGELAS
SOUTH WINDSOR CT.96074 Type of Work.:.DRIVEWAY
Phone (860)528 2684
Applicant agrees to furnish the::Towa o.f South Windsor the amount of bond
required and to reimburse th indsor or any: expenses
incurred by the Town for maintenance or repair work is connecton with this
permit and that applicant is 'am!.liar w3,t1' and -*-ill wide. by .the rules and
regulations for permits as outlined in the T: of South Windsor's Street
Cut Permit Manual.
* * PERMIT TO/,BBE KERT/ ON JOB ,SITE AT ALL TIMES.
Issued by C 1 / `L�J1�}l Titie
---------------------- ---Y----
Date Completed Inspected B "
TOWN OF SOUTH WINDSOR INSPECTION REPORT
" Permit No. 3523 Contractor CUSTOM PAVING
Location 0411 SLATER STREET Addreis.s JOHN F::JURGE.LAS
Type Work DRIVEWAY P.. O. $OX 17$
SOUTH WINDSOR CT`>..06074
Phone"No '860)5'28-26;84
Date Insp Needed D ate I:ns
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Time Insp Needed _T_ Time
Inspected By
Work in Progress
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s
Input..__ - - 'Date __—
APPLICATION FOR STREET EXCAVATION 5 PERMIT 2j
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm L L`�S7O(-1 Phone No: ,52p,:�c O y
Address of Firm / IT 54 W
Location of proposed work
Describe fully nature of permit requested 42 W 0 1-1 ve
Starting date Approx.time for completion
Cali Before You Dig No. e o p 2/0 9 Traffic Services Control No.
Show sketch of proposed work or furnish be filled out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North Prop. size of cut
No.cuts
Amt.of Deposit$ by
O Cash O 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:_ L 9 f 1i o7�
Title: // /3 D.L.#: ✓/ /?c{Sd' -9 ?C&7,
PERMIT SHALL BE KEPT ON]OBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc