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` TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. , 3782 Cont raor AIROTbTES INC.
Location
Ares .,: 0 $
Type Work DRIVEWAY
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' Permit No. 3782 Town of South Windsor, CT
Date 07/02/2004 `4 :...:.:.. " �
"' u •;� Street Excavation Permit
Expiration Date 07/02/2005 4q00
Applicant : .:
Name AIROLDI'S INC. vy yy
RVIZV
Addr. P O BOX 71
ff: .,.,� Zk
SOUTH WINDSOR C 'tTG '4;:z if'a3 .
Phone (860)289-3876 '%> Viz:
Applicant agrees to I! t k
. F in e5r`<': e`< rto: n bond
Sx t o f
requiredand to rei b'ur' y" "` `°' Y''
�0. s.e:. . ovf :" '> :..: ,
incurred by the Town':;fb ; m4:1.te.A nqe ,.,x::;:•. .e
a1><' o:i c ;:ti n with this
permit and that applant i'e .'frrtr. :a :'': a.y c] ,by the rules and
regulations for ermit's a '' ' "�.
P oil fi l'3 n ed' < #'; .a >s'T tv s crf S: .u.t'h,.,Yt' 7id o i s Street
A.Cut Permit Manual.
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PERMIT TOGSU KEPI' DN J I AT: A,IX 'TI1K' S.
Issued b :::.. ,;>' .�''�,. ��•,.
Date Completed ------- Inspected By
• 3'18�
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Finw`- Phone No.
Address of FlrmSZS:�,�, �N
Location of proposed work
Describe fully nature of permit requested
Starling date -27 Approx.time for completion
Call Before You Dig No='��� �?.�_Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North Prop.size of cut
No.cuts
Amt.of Deposit$ by
()Cash()Check#
Cut size after Perm. Patch
No. Cuts
Final Billing$
Amt. Due Payee$
Amt. Due Town$
Applicant is responsible for contacting by 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 IN THE
TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Sign �� Date:�Q mac\
Title: D.L.#:
5 �—
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PERMIT SHALL BE KEPT ON 306SITE AT ALL TIMES
RECEIVED
Standard Forms\Permits\Street Excavation Pennitdoc JUN 3 0 2004
SOUTH WINDSOR
ENGINEERING DEPT.