HomeMy WebLinkAboutDriveway Street Cut Permits 129 Fairview TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 3793 Con 'ctor QUALITY""PPITzNG CO.
Location 0129 FAIRVIEW DRIVE " '"^' `
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Type Work DRIVEWAY
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Permit No. 3793 Town of South Windsor, CT
y Date 07/12/2004 Street Excavation Permit
Expiration Date 07/12/2005
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Applicant
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Name QUALITY PAVING CCU'
Addr. 194 S. MAIN STRIAT •:
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EAST WINDSOR C1 306:08s;$ ^.. """'
. ,' WOV bRIx7B:WAY
Ph
one (860)523-4182
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Applicant agree$ cz furtz�Csh •the ti. fx fs
!� dfi ¢ h Winds e..amdunt of bond
required and to reimbixrse bhe .flown ofFotith # irtdsoror.an 'exPnses
permit
by the TocSn-,,fc3r taiaserti ! � egh work � unectign with this
and that app`.1i� it jayam1` :arry��:y .::ay�. y } e b,y CYyae rules and
regulations for permits as;:oaik3a ;;. . .. es # oxzth W�indsAr's Street
Cut Permit Manua l.
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* * (PERMIT �O BE KPfT ON cF � � , A L TTM�:S,
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Issued by �
it}e — -----------
Date Completed """
APPLICATION FOR STREET EXCAVATION PERMIT 3 7 T j
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOk CT
FEE $25.00
Name of Firm °���� .�J'�/1 C o hone No. o< I p
Address of Firm �,NA Suf (� O
Location of proposed work a -t
Describe fully nature of permit requested
Starting date - Approx.time fdr completion
Call Before You Dig No. Traffic_Servi=-Control No. - -
Show sketch of proposed work or fumish To be filled out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North Prop.size of cut
No.cuts
. Amt.of Deposit$ by
()Cash()Check#
5 Cut size after Perm. Patch
` + . No. Cuts
�O Final Billing$
Amf.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.
4 Signed: Date:
Title: PC�. --
PERMIT SHALL BE KEPT ON 308SITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc