HomeMy WebLinkAboutDriveway Street Cut Permits 18 Carey Lan (2) TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 3939 C :,::uu?:aww:oi�:;»»,:,wiuw'a,
�nii tra t.P r QUA„L,ITY""'PAVING CO.
Location 0018 CAREY LANE
Type Work DRIVEWAY WINSEiR Cfi... 06088
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Permit No. 3939 _ Town of South Windsor, CT
Date 04/18/2005 ,> > Street Excavation
t on Permit
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Expiration Date 04/18/2006
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Applicant < w..
Name QUALITY PAVING CO.
Addr. 194 >�';.:•:,
S. MAIN STYE` '
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AST WIND SOR
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Phone (860)523-4182
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Applicant a ree'S to E: r' : t. xy."
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g ...b,�st.'<: �:. t>.' >;�;aytt:h Windsa`V.:fhe'<..1-ambunt of bond
required and to remb`u'rs"'''r [> s'a:T` `'ool : ex ,os3t.k': sor. f:A `...an :.: 'enses
incurred by the Town Vfo`r`ririC ante re
., ire"'`'conrieq.tion with this
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permit and that appl,d8ant 'asamliat7q� � at w;;�� bide'>'by .the rules and
regulations for perm :: s a's, aut`tine;:< jer.; r ;of ,ua:tth.` 3`n.eTsor's S}t: treet
Cut Permit Manu
al
* * PERMIT TO:: E` I I:,r. QNJC7B' SITE >ATz I tT.A'ES.
Issued by lm" 1 1 p -----------------
Date Completed Inspected B
APPLICATION FOR .STREET EXCAVATION PERMIT 3C( 39
' TOWN OF SOUTH WINDSOR Per-
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT 06074
_ FEE $25.00
Name of Firm
v"
Address of Firm
Location of proposed work
Describe fully nature of rmit requested41�
d 71� �' Ct/L. Ce 'Z r 7` i
St rtm date
g Approx.t me for completion
Call Before You Dig No._ CJC) J� ' Traffic Services Control No.
Show sketch of proposed work or famish
two copies of separate drawing Indicate North This section to be tilled out by
Town of South Windsor
Pavement Cut
No.cuts
f I � Est.Size of Perm.Patch(s)
I C, Est.Pvt.ThicImess in.
f
Est.Unit Price$
Amt.of Deposit$
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( Total Due$ by
111 ( )Cash( )Check#
/ Permanent Patch
11 No. Cuts
Size of Patch(s)
Final Billing
Amt.Due Payee
$
Amt.Due Town
BY
Applicant is responsible for contacting Date
the Police De X.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 PERMI!IANU�t.
Signed:
_ Date: 7
m-r
Title: Driver's License#:
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES