HomeMy WebLinkAboutDriveway Street Cut Permits 17 Fairview k TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 3708 Contr,a.ctt5t''A'IROLD:I.: S INC.
Location 0O17 ."2 BtkTYF; Address P
Type Work DRIVEWAY SOUTH WINDSOR CT 06074
Date Insp Needed717
Date S.i�sp f717
Time Insp Needed ---_--_-- Time IajSp
Inspected By
Work in Progressji
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Input Date _—
Permit No. 3708 Town of South Windsor, CT
Date 05/18/2004 Street Excavation Permit
Expiration Date 05/18/2005
Descrip:
Applicant Lpeat,ion
Name AIROLDI'S INC. DkIVE :'
Addr. P 0 BOX 71
SOUTH WINDSOR CI O.974 'T" i o WO;V DRIv WAY
Phone (860) 896-0401
Applicant agrees tQ fu:. the.T:pwr cif' St ut,h Wirt s'b tYie amount of bond
required and to reimburse th.e Town of SoUitli Waridsor for any <expdnses
incurred by the ToWri for''sma2ntenance;; Cad r Tr rk iri' p.pne:ctiOn with this
permit and that app�ica.,nt as:'.familia wits and xa11 ab:�de b;y the rules and
regulations for permztS"'as oiTtlared :xh�, Tct :o Windsor's Street
Cut Permit Manual.
* * PERMIT 1.0 BE KEPT ON J333 w: p5 AF:: ATrL ,T7ME5
Issued by ----
Title --------
Date Completed L.rzs.p.e.ete'cY By —__--
APPLICATION FOR STREET EXCAVATION PERMIT p�
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm������' Phone No.
Address of Firm
Location of proposed work \�
Describe fully nature of permit requested
Starting date Approx.time for completion '�5 Z E Q S
Call Before You Dig No Traffic Services Control No.
Show sketch of proposed work or furnish I I To be filled out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North Prop. size of cut
No.cuts
Amt.of Deposit$ by
()Cash ()Check#
Cut size after Perm. Patch
No. Cuts
IFinal Billing $
W Amt. Due Payee Y $
Amt. Due Town $
Applicant is responsible for contacting by date
the Police Dent. 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 PERMIT MANUAL.
Signed: Date: ���
Title: D.L.#:
PERMIT SHALL BE KEPT ON]OBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc