HomeMy WebLinkAboutDriveway Street Cut Permits 343 Clark St (2) TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 4028 C�n 'raGtgr QUALITY""E�AVING CO.
Location 0343 CLARK STREET %Ad��e�� ' 194f�5 �N1A N 'STREET
Type Work DRIVEWAY g� WINS OR CT,;,06088
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Date In sp Needed
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Permit No. 4028 Town of South Windsor, CT
Date 07/08/2005 Street
Excavation Permit
Expiration Date 07/08/2006:
Descrip: '...
APP licant''
Name :>
4UALITY PAVING;CO. RE�'ik
Addr. 194 S.. MAIN STPEFsTi
EAST WINDSOR 'C'�...:0:6�93"" x'` :•<..;:..:«. ,:,
Phone _
(860)523 4182 >:�,, �:ga•
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Applicant agre-As tS: itk si >:zt:Yz Win '' r ,<
#. ., bh!9>"'6Kount of bond
required and to rembursa Toi rAfr an` 'e�ac'enses
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incurred by the Towb'.yf 'o8ngpax�:os, �e_ ajz;::,;. x3c.,t.<h; 'on :ct'ion with thi
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permit and that applicant "asaui�113 �"aCi�y,�l;p''ab�de by the rules and
regulations for perms. s, oAt: ieci <;' s< :>.; iyfh;: f : .outh "t�ri3sor's Street
Cut Permit Manual. yz
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* * PERMIT TO'"`'BE 1,"P ;ON'JOgSITE. AT-Att T, MES.
Issued by �f Y fiit� n
Date Completed __-------- Inspected By
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APPLICATION FOR STREET EXCAVATION PERMIT yoz ,
TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT 06074
FEE $ 00
Name of Firm Phone No. ` - ( -3
Address of Firm
Location of proposed work `� �l 3 /' ✓� �,. �l�v �� I
Describe fully nature of permit requested
Starting date_ -7 - /U G 4r-- Approx. time for completion
Call Before You Dig No. Traffic Services Control No.
Show sketch of proposed work or fumish This section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
Pavement Cut
No.cuts
Est.Size of Perm. Patch(s)
Est. Pvt.Thickness in.
Est. Unit Price$
Amt.of Deposit$
Total Due$ by
( )Cash( )Check#
Permanent Patch
No. Cuts
Size of Patch(s)
Final Billing
Amt. Due Payee
Amt. Due Town
By
Applicant is responsible for contacting 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 I HE T WN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: /"/ Dater — �— -- Q f'
Title: Driver's License#:Z Z 6 S 7 d Z 7�-
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES