HomeMy WebLinkAboutDriveway Street Cut Permits 281 Foster S TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 4034 pn ract(.?,vi IROLDI'' ='> NC.
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Type Work DRIVEWAY
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Permit No. 4034 Town of South Windsor, CT
Date
07/12/2005 Street Excavation Permit
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Expiration Date 07/12/2006>' ;>. ' <:,
Descrip:
Applicant? '.;�;; •�•
Name AIROLDI
Addr.. P 0 BOX 71
SOU
TH
H W IND S OR 47 6#3.7s":
Phone 860
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Applicant
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WinrY of bond
required and to re ra A � �V,
q mb sR'' e:y:Town>.,s;: 2YIt'1' f ".'."ary>... ex'enses
incurred b . <;>s:;>.,z;,,
Y the Tow `:for rii 'itri'aric' rr
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permit and that appll cant x:s ain''3:
he rules and
regulations for permi`t:s''as,>.ou, ' ;,rieiii sor s Street
Cut Permit Manual. ,r ;
* * PERMIT TO BE, K9P,.:T,`�JnT.?'J�$-:<.SI��'�TsA:LL TIMES.
Issued by ----- — — ____ ,:.' ='-- -----
Date Completed ...—....—..... Inspected By
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR �1 t
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm Phone No.
1
Address of Firm
Location of propose work
Describe fully nature of permit requested
Starting date Approx.time for completion U —
Call Before You Dig No.- Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
�-•�. 1 ' --� ` Pavement Cut
Indicate North
I ' Prop. size of cut
No. cuts
9G Amt. of Deposit$ by
( )Cash ( )Check#
V
`3° Cut size after Perm. Patch
No. Cuts
Final Billing $
— Amt. Due Payee$
2 Amt. Due Town $
Applicant is responsible fcr�onta by date
the Police Dept. and C. .Y.D.
I AGREE TO FURNISH TO THE TOWN OF SOUTH WINDSOR THE AMOUNT OF BOND REQUIRED AND TO REIMBURSE THE TOWN
SOUTH WINDSOR FOR ANY EXPENSES INCURRED BY THE TOWN FOR MAINTENANCE OR REPAIR WORK IN CONNECTION WITH T
PERMIT AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR PERMITS AS OUTLINED IN
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