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TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 2523
Contractor STATE LINE SEWER & CONST CO
Location 0434 FOSTER STREET
Type Work WATER Address 238 SHAKER ROAD
ENFIELD CT 06082
Phone No. (860)749-6176
Date Insp Needed
Date -,Xnsp.
Time Insp Needed
i01.
Inspected By
Work in Progress or
Input Date
Pe�mlt moo. 2523 Town of South Windsor CT
Date 01/06/1999 Street Excavation Permit
Expiration Date 01/06/2000
pescrip:
Applicant Location
Name STATE LINE SEWER & CO T QO <=
0434 FOSTER STREET
Addr. 238 SHAKER ROAD
ENFIELD CT 06082
Phone (860)749-6176
Appl icant agrees tQrgM fi "► f`
required and to reimburs2kP, �r � fY4. 1 or the amount of bond
wra c�tf~�� hr fcr any expenses
incurred by the Town to n���� � spa i°I� �hk ����{°n� connection with this
permit and that app1i(iant ami�]. an4w, f abide by the rules and
regulations for permits asp 1 ' o► ; �Uth Windsor's Street
Cut Permit Manual . �
* * PERMIT TO-, 8 '1 CQ T `ATA ,L TIMES.
9
Issued by
T i ,--
Date CompletedInspected By
- 25Z3
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 Firm _ear-tfA�� � � ( pL'Y`1 S�TVLt fLflb►'� Phone No. 176,
Address of Firm�2,R
Location of proposed work 42'!4, Y�. �'.�
Describe fully nature of permit requested di-)ce__�ef
Starting date l �"�1 Approx.time for completion
Call before you dig no. .9 C?yaae)l0 cl I Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of So. Windsor
two copies of separate drawing Pavement Cut
Indicate North L 10 Prop.size of cut ; &"
No.cuts
Amt.of Deposit $ eO 16 by
Cash DfCheck#f
(ago I Dla -� Cut size after Perm. Patch
I
_ No.Cuts
FF0s-�
Final Billing S
Amt. Due Payee $
Amt. Due Town $
Applicant is responsible for contacting
the Police Dept.and C.S.Y.D. by date
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: �- l0
Title: - D.L.# (D;� 161-7 7- l �� r
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES