HomeMy WebLinkAboutStorm Street Cut Permits Deming and Buck TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 3901
Location ECHN C0T'ftractgr S :S. CHO FARMS
Type Work STORM A4dre�s P.C�' '' SOX ,581'>
SBL7RY ,CT 06070
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Date Insp Needed
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p Needed s p f fit,
Time Ins -r
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Inspected By
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Work in Progress j
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Input
Permit No. 3901 Town of South Windsor, CT
Date 03/14/2005 Street Excavation Permit
Expiration Date 03/14/2006:;
Descrip:
Applicant L`ocatiGs:n
Name SIMSCROFT ECHO FARMS
Addr. P.O. BOX 581
SIMSBURY CT 06:070pe;,pf Work sPC3'TtM .
Phone (860)651-0231 :
Applicant agrees ,ter funLs}� :the ZcxyZ p South:.,Windso.r the'""'abunt of bond
required and to reimburse::*th:e Town.A, SZJ t1' fS d for tcar;; any expenses
incurred by the Town :far 'tnainte'riance a e w�3r, xxi onnett-don with this
permit and that applicant. is fa'iyiiar'vr�t2YY3C3 w <likiz'de by.;;the rules and
regulations forpermit ::As.. dut`tin:e`<> >`C`F' ?'".'`ai`:;:
b ::>
25 of;=" W'i4asor s Street
Cut Permit
Manual.
* * PERMIT TO °SE, 1ZZP'I' -ON,,.JOB, SIF,AP'`=All T::1.MES.
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Issued by ....--
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Date Completed .....—....__---- Inspected By _ ice- i lr
APPLICATION FOR STREET EXCAVATION PERMIT 3'=
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT Permit No.
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT 06074
FEE $25.00
Name of Firm Phone No.1L,�� 2:� 5 j
Address of Firm
Location of proposed work
i
Describe fully nature of permit requested
Staring date_ ;1 Approx. time for completion
Call Before You Dig No,.Z00,� -/Q� ,/��!'� _Traffic Services Control No.
Show sketch of proposed work or fumish
two copies of separate drawing (` Indicate North This section to be filled out by
Town of South Windsor
Pavement Cut
-- -- - ----- No.cuts
Est.Size of Penn.Patch(s)
f Est.Pvt.Thickness in.
Est..Unit Price$
Amt.of Deposit
Total Due$ by
Cash( )Check#
Permanent Patch
No. Cuts
7-1 I Size of Patch(s)
Final Billing
Q� $
Amt.Due Payee
$
I Amt.Due Town
$
By
Applicant is responsible for contacting Date
the Police De t.and C.B.Y.D.
1 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 O LINED I TOW OUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed.
— I D
Date:
Title: �W _ ,
Driver's License#:__ Z 9 3 f `
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES