HomeMy WebLinkAboutDriveway Street Cut Permits 89 Beelzebub PeirNo• 3296 Town of South Windsor CT Date= 05/23/2002
Street Excavation Permit
Expiration Date 05/23/2003
.,Descr i p:
Applicant
Location
Name CUSTOM PAVINGBtE BUB ROAD
Addr. JOHN F JURGELAS
SOUTH WINDSOR CT 0 0 DRIVEWAY
Phone (860)528-2684a
4
Applicant agrees } h or the amount of bond
required and to reim u o th r any expenses
f
incurred by the Town f e a pai i connection with this
permit and that appli otit an ide by the rules and
regulations for permi 7 f th Windsor's Street
-Cut Permit Manua , OW
y
* * PERMIT T T LL TIMES.
Issued by QC vq �
Date Completed °
Inspected By
TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. Contractor CUSTOM PAVING
LocationAddress JOHN F JURGELAS
Type Work fR=IVEWA"Y =W P.O. BOX 178
SOUTH WINDSOR CT 06074
&gne (860)528-2684
Date Insp Needed i4s
Time Insp Needed
a�
Inspected By
f
Work in Progress
k*01 %A
Date 7 1
APPLICATION FOR STREET EXCAVATION PERMIT �)"q 1p
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm V S--t O
Address of Firm o , Phone No.
Location of proposed
Describe fully nature of permit requested
Starting date i Approx,time for completion
Call Before You Dig No. Traffic Services Control No.
Show sketch of proposed work or furnish
two copies of separate drawing To be filled out 6v Town of South Windsor
Indicate North
Pavement ,�
Prop.size of cut
No.cuts
Amt of Deposit$ by
O Cash O Check#
Cut size after Perris. Patch
No. Cuts
Final Billing$
Amt.Due Payee$
Amt.Due Town$
Ll�;ewntacting by
. date
I AGREE TO FURNISH TO THE TOWN OF SOUTH WINDSOR.THE AMOUNT OF BOND
UIRED 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 WINGSOR'S STREET CUT PERMIT MANUAL
Signed: .... y
Date:
Title:_ D.L#: „318 7/f�.�•
PERMIT SHALL BE KEPT ON 308SITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permitdoc