HomeMy WebLinkAboutDriveway Street Cut Permits 601 Dart Hil TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No, 3955
Location 0601 DART HILL ROAD C°< ltact`or L&MN:PAV:ZNG
, lddr `zD V,ER ROAD
Type Work DRIVEWAY
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Permit No. 3955 Town of South Windsor, CT
Date 05/03/2005 Street Excavation Permit
Expiration Date 05/03/2006 € Y
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Applicant 1'
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Name L&M PAVINGSH L'L„R0AI)'
Ad x'dr. 139 DOVER R OAD>'
WEST HARTFORD CT p6JI7 :•* pe �xWrk ARTVEnIAY
Phone (860)233-6528
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Applicant agrees "£'o: tu''rUIsh the;<TZ)iq `. f:;<: :''. th WinG3S. h ... " unt of bond W. .. 4:�= a o d
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required and to re' j}us ;;a.k " t >'r; .
,i 9y1•„ .:. ,.:JP; dsor.; �o'Y"'Z.any::::: x senses
incurred b the Toi4n«::2Y3r''s 4:;;:.. ,; g.:':. >:' ..
Y i J.i enafdp^<:o " Yepai' s"G3o '".i? `rt5n n uectao with this
permit and that app i ant<. 3:; e by r
regulations for permits as
�... b; 'he rules and
'Q}tlYfed€< isft}ie' ?at;"of 'th"•k,xnd'sor's Street
Cut Permit Manual.
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* * PERMIT T ,BE X-2 RT OTC'.::xQR'`.S ;TE'"'A ..•A'lL. 'TIMES.
Issued by � 1�'
Date Completed Inspected B
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT Permit No.
TOWN HALL
1640 SULLIVAN AVENUE
SOUTH WINDSOR, CT 06074
FEE $25.00
Name of Firm � yYl
Address of Firm Phone No:_ r�
Location of proposed work
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Describe fully nature of permit requested
Starting date t rT is
Call Before You Dig No. ( � /��� �— r'��'time for completion
raffic Services Control No.
Show sketch of proposed work or fumish
two copies of separate drawing Indicate North This sewn on to bh Windsor
out by
Town of South Windsor
Pavement Cut
No.cuts
0 Est.Size of Perm.Patch(s)
Est.Pvt.Thickness �.
Est._Unit Price$
Amt.of Deposit$
---— Total Due$- by
G ( )Cash( )Check#
< c/ Permanent Patch
r �,q� No. Cuts
' Size of Patch(s)
Final Billing
a
Amt.Due Payee
Amt.Due Town
Applicant is re By
sponsible for contacting
the Police Dept.and C.B.Y.D. 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 I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR
PERMITS AS INE THE T N OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed:
Date:
Title
Driver's License#:
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES