HomeMy WebLinkAboutDriveway Street Cut Permits 20 Gorski Dr TOWN OF SOUTH WINDSOR INSPECTION REPORT
Termit No. 3790 Cont for"'AIRC3 T5T'+•5:.:,
Location 0020 GORSKI DRIVE ?NC.
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Type Work DRIVEWAY - ,SOUTH W' NIt7R,4C'P:;., 06074
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Permit No. 3790 Town of South Windsor, CT
Date 07/09/2004
Street Excavation Permit
Expiration Date 07/09/2005
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Applicant
Name
A IROLD I S INC. �.
Addr. P O BOX 71
SOUTH W H r•.w,.,: ..a:'.'.1` ;
INDSOR C: 'fti'�.tl7� `^ :•
ate' •e«�5f`�::.
Phone 60 8 289- .•:( .:.3 87
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plicant ca n t a
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,W:. .:off '�;t?:F.,'I,'�i Winc3iSor`�:t`I�er`amoTan
required and to reiinb. :y t of bond
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incurred b the T %"• :`•:
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vn
with
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permit and that appleck
:::.::.::c4:` �ht>rid;;,zv: : >''.db`1d� b"'::s>.:the rules es and
regulations for permits as tit] npd 4 i:$' "N' '. crt ° ' h'' `inc3s'WSr s Street
Cut Permit Manual.
PERM
IT
Issued by
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Date Completed U(� /
—[G=L _ _`� Inspected o
i
Slqo
t APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Fi Phone No. �—
Address of Firm" �Location of of proposed
Describe fully nature of permit request
Starting date `� Approx.time for completion '
Call Before You Dig Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North Prop.size of cut
No.cuts
Amt.of Deposit$ by
()Cash()Check#
Cut size after Perm. Patch
No. Cuts
Final Billing$
Amt. Due Payee$
�- Amt. Due Town$
------------
Applicant is responsible 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.
r
Signed:
Date:
Title. D.L.#:
PERMIT SHALL BE KEPT ON]OBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavabon Permit.doc