HomeMy WebLinkAboutDriveway Street Cut Permits 111 Gorski D TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 4031
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Location 0111 GORSNI DRIVE ` i
Type Work DRIVEWAY ,:lYAda3e SAM£'' 'ABOVE:.;;.
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Date
r Permit No. 4031 Town of South Windsor, CT
Date 07/08/2005 Street Excavation Permit
Expiration Date 07/08/2006
Descrip: TWO CURB CUTS
Applicant
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Name HOMEOWNER i Ji, y £03 ' .G0I*w�l'a2, b �tF
Addr. SAME AS ABOVE }
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SOUTH WINDSOR T':a"6o74 .
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Phone (000)000-0000
Ap
plicant
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PP 9 � u 'K1,�:.51�' nva�Y`�#��'�" �tth Wig �'�r ' CheF�"am�unt of bond
required and to reimburse th Towx),•sit1 # �adsorc�z ;a}�y �Xpenses
ass
incurred by the Tovri' for'sir�� zterxtt9d s`r4{ e '+Nork Uzi Connection with this
permit and that ap1Cnt8: ami�Sar with andil arscle .kty.te rules and
regulations for pertinY>t's a"'" U.E ' tt ["','. ,'.` """' rrr`"' €,. `oz' :kliridsor s Street
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Cut Permit Manual. xt.
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* * PERMIT"'TO $ >,.KgP.:�:::`p. r K T
Issued b ---_--
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Date Completed >:11"s"vected By
APPLICATION FOR STREET EXCAVATION PERMIT 11031
TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT 06074
n FEE $25.00
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Name of Firm t�-en/e.�1 1"ad j'--V f Phone No. 2S7��J3/
AddressofFirm_ Cromwell Y{H. kock, t WILLL, L 066G-7
Location of proposed work lit
Describe fully nature of permit requested Qep fliLL ,ex ky wRy /Vj.6
New `1t14eWWj
Starting date jury I Approx. time for completion_
Call Before You Dig No. Traffic Services Control No.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
(u Pavement Cut
No. cuts
C p jvcre Est.Size of Perm.Patch(s)
l' .. Est. Pvt.Thickness in.
S
Est. Unit Price$
Amt.of Deposit$
Total Due$ by
( )Cash( )Check#
Permanent Patch
No. Cuts
Size of Patch(s)
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 gOT LI ED IN THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMI MANUAL.
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Signed: Date: ��`�.�
Title: /� ' Driver's License#:
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES