HomeMy WebLinkAboutMiscellaneous Street Cut Permits 250 Bro TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No, 2418
Location 0250 BROOKF.IELD STREE Contractor HOMEOWNER
Type Work MISCELLAN Address SAME AS ABOVE
SAME AS ABOVE
SOUTH WINDSOR CT 06074
Phone: !NC :- ( O00)000-0000
Date Insp Needed
nsp
Time
Insp Needed -._---
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Inspected By
Work in Progress
Input Gate
'permit No, 2415
)ate 04/1 5/1 998
.town of South Windsor,
Street Excavat i can Permit T
=xpiration Date 04/15/1999
)escrip:
Applicant
ame .� j Location
dr. }�� , ROoCLD STREE
ISCELLAN
Applicant
u r'!
pp 1 i cant agrees
required and to re i mbr rho pf 5 } i
incurred by the Town �� oWff�° h W� e r the amount of bond
Permit and that ap l ior � 8C1 yt� f a� r Y. cr any expenses
regulations for p oani ar � � k�� connection with this
Permit ,
Cut Permit Manual . v4,
� �de by the rules and
� 44o Windsor's
t ' th Win Street
9t
* * PERMIT TO L�PT N {
;sued by
ITF LL TIMES.
T%tie{ _-
to Completed � " • _._._
Inspected By
t 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
b
Phone No.
Address of Firm
Location of proposed work S'97j'I
Describe fully nature of permit requested g e
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 So. Windsor
two copies of separate drawing Pavement Cut
Prop.size of cut —
2gv�C�' e/ s f
-- No.cuts !f
Amt.of Deposit t by
f ' (`
()Cash()Check 1i
S,�Sds Cut size after Perm. Patch
No.Cuts
Final Billing S
Amt.Due Payee Is
Amt.Due Town 0
Applicant is responsible for contacting 7�
the Police Dept.and'C.S.Y.D. by date
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 1 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.N
PERMIT SHALL BE KEPT ON JOSSITE AT ALL TIMES
�jir�•y s'�o/r�v�l ��/l��