HomeMy WebLinkAboutDriveway Street Cut Permits 614 Foster S TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 3668 Conta 'or' QUAliT`TY<»:: .AVING CO.
Location 0614 F09TER ST ET .<90"... $ �20 ROP p
Type Work DRIVEWAY
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Permit No. 3668 Town of South Windsor, CT
Date 04/13/2004 <r•v Street Excavation Permit
4 Expiration Date 04/13/2005
Descrip:
Applicant
�..
Name QUALITY PAVING CGS ..
.
POSTER "'B'`I`REET.. : ..°
Addr. 90 STRONG ROAD
SOUTH
U H WINDSOR CT
- 0"6'0 7"4. f:;;4aptx
Phone _ ..``(
(860)523 4182
3,
Applicant
can t a r ees<'. .,, he' To:::>
vr�,.,o..'•,";� Wind''
5o'Y'Y'zt1!er"a�yoTint of bond
required and to reimb ;$ei "t,3`e%;< as a:"r. :3s':';`ti::.`s ..'u2 If, ti d or fti r,_:ai y expenses
curred by the Town; fo,. ;. raa:aanar >'rir:
x,,. A a :;;;nrcra'nect 4n with this
permit and that appl` caa }'k:s:J'.": ? 1::i:a ;sa :f
s ;. rules and
regulations for permits as. outline'"
? ".fix .,.inrls:or s street
Cut Permit Manual.
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PERM
IT TO`:: EK���'T ''0'N:...,,'�,B'"'�:S'TE`�'��r`A''r .•T'INt$' * *
Issued by Date Completed _------ Inspected By
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
cc cc �c Cwz , �'
Name of Firm C er— -� Phone No.
Address of Firm
Location of proposed work
Describe fully nature of permit requested
Starting date �° prox time completion Q�
Call Before You Dig No i 7 Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North L c Prop.size of cut
No.arts
{, Amt.of Deposit$ by
Cash()Check#
�E�✓ Cut size after Perm. Patch
No. Cuts
t Final Billing$
� p 1
Amt. Due Payee$
Amt. Due Town$
Applicant is responsi a 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.
Signed: Date:
Title:_l1 tic` �,. -C'C�,p�t� r� D.L.#:
PERMIT SHALL BE KEPT ON]OBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc