HomeMy WebLinkAboutDriveway Street Cut Permits 420 Benedict Permit No. 3775 Town of South Windsor, CT
i Date 06/28/2004 " ' "" "" •... Street Excavation Permit
Expiration Date 06/28/2005 f`" "^y -•"' 1"
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Applicant
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Name AIROLDI'S INC. BENEDICfykD,[LIVE
Addr. P O BOX 71 x,
SOUTH WINDSOR C fl074 p }. y 3VE75Y
Phone (860)289-3876 «:•r' � f:
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Applicant agrees,": to^-`'f34 i�5.�pi>:'the mkt" f. ,F p :`� Wind q�.«C'"e:a `o.unt of bon
required and to reiikstSe4 �- of � �� u.�h $li �r,f�rnae ses
incurred by the Towns f0-1' fhA tftaneIg''or=f Gi#r" Y'k. n. ctiQn with this
permit and that appl .c—
:v1; i•d# .kjy Ebe rules and
regulations for permi s as:.. r tt 4iriec3z i die s ts?',` ' Sgath Wa,xigb.dr's Street
Cut Permit Manual. flxx ` s � .» h'`,
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* * PERMIT TO i�E
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Issued by s'
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Date Completed ...—........—... Inspected B "4Aj%
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 3775 Cont.z.4,u 6'rAIK'b'n�.i,9.' INC.
Location 0420 BENEDICT DRIVE A&rresi ' -?S O b Xr _.lYfX"">
Type Work DRIVEWAY " ' '
?LITH Wl,NP R. CT':.. 06074
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Time Insp Needed
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APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm Phone No. �'\ ����_k,-V
Address of Firm
Location of proposed work
Describe fully nature of permit request
Starting date —\ \ Approx.time for completion
Call Before You Dig No Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North Prop. size of cut
No.cuts
Amt.of Deposit$ 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.
Signe Date:
Title: �\ - D.L.#:
PERMIT SHALL BE KEPT ON 3OBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc