HomeMy WebLinkAboutDriveway Street Cut Permits 82 Felt Road (2) TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 4098 Contrac:tbr HOMtOWNEp,,.
Location 0082 FELT ROAD Ad`dress:3 11:::,:SAM9>=»XIS .ABOV'E„
Type Work DRIVEWAY SiAME AS"ABOVE,
QUTii W'I'NPSOR CT '0:6074
P !bneNo (&3g0)000 A00Q
Date Insp Needed
----------- Date 'Inp
Time Insp Needed
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Inspected By
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Work in Progress
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Permit No. 4098 Town of South Windsor, CT
{ Date 10/05/2005
Street Excavation Permit
Expiration Date 10/05/2006
Descrip: EXCAVATE TO REPAVE,:::AND *WID,Z b.R,I.VBWAy`;.'""`•'..•^..::.
Applicant Locztidi
Name HOMEOWNER pff82 FELT ROAZk
Addr. SAME AS ABOVE
SOUTH WINDSOR CT A6,074ae esEc5r .L}} IVFWy,
Phone (000)000-0000
Applicant agreedi to •fush the T. Qf SQUeh Windsor thernount of bond
required and to reimburse :thy u.th75xicisor,, ftar any expenses
incurred by the Tow nr rt�aitenance or Yepair"work' in opn
3ctisin with this
permit and that appllc'ant ks-;f— it + i and Wi'l1' .abit e ,by t}3e rules and
regulations for permits a I:.,o"Ethine;C;;` xj ! , qK of ScSuh T '..
andSor s Street
Cut Permit Manual.
* * PERMIT TO BE T ON JOI3SI$E AT, A1I,:T�M�S.
Iss �!
ued b J v
rr
Y16,
Date Completed —__-------- Inspected By
• APPLICATION FOR STREET EXCAVATION PERMIT ` og,5
TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT 06074
FEE $25.00
Name of Firm �`' GT _fZ ;iV r JC77A,,�^ Phone No. &0
Address of Firm
Location of proposed work
Describe fully nature of permit requested
Starting date 40 Zzz Approx. time for completion
Call Before You Dig No Traffic Services Control No.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
Pavement Cut
No.cuts
0 Est.Size of Perm. Patch(s)
Est. Pvt.Thickness in.
Est.Unit Price$
Amt.of Deposit$
Total Due$ by
( )Cash( )Check#
Permanent Patch
No. Cuts
Size of Patch(s)
! i Final Billing
( Amt. Due Payee
$
Amt. Due Town
$
By
Applicant is responsible for contacting 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 1 T E TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: Date:
Title: Dc�,�y� Driver's License#:
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES