HomeMy WebLinkAboutDriveway Street Cut Permits 564 Graham R Permit No. 2497 Town of South Windsor CT
Date 09/28/1998 Street Excavation Permit
Expiration Date 09/28/1999
Descrip:
Applicant eo Location
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Name HOMEOWNER w ' 03 ,,GI 4HAir1 ROAD
Add r. SAME AS ABOVE
SOUTH WINDSOR CT 06k 7 k �� t? Vol*,"ZRIVEWAY
Phone (000)000-0000 rAOr
Applicant agrees td wn he� � y
required and to reimbr � a� for the amount of bond
�' w0 �th W i a{� any expenses
incurred by the Town ' '
' t;ene�e paitr� ci,ti n"� connection with this
permit and that app 1 ian a° th
a � � an �1 4 de b
regulations for permits aslt Y^ r -,oW'j ► 5� th Windsoe'sules Streetd
Cut Permit Manual . '.
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* * PEERMIT TO $E ,. KEPT iA JOB. SITE°'AT ALL TIMES.
Issued by n'�2►�A i T7 tl
Date Completed `Inspected B�
TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 2497 Contractor HOMEOWNER
Location 0564 GRAHAM ROAD Address SAME AS ABOVE
Type Work DRIVEWAY SAME AS ABOVE
SOUTH WINDSOR CT06074
PhaeNo n (000)000-0000
Date Insp Needed ,: Dade Ins id�1 ��8
Time Insp Needed , : Tirr Insp
Inspected By �� .� �
Work in Progress �� jS' � 1 raj, � c�l
00
�..,Inllput Date 14161 ic
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APPLICATION
OWON OF SOUTH EXCAVATION PERMIT
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm lX L Phone No
. C� 5 /
Address of Firm 11
Location of proposed work 2-2
Describe fully nature of permit requested i(
Starting date -0 Approx.time for completion
Call before you dig no. 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 Prop.size of cut
No. cuts
Amt.of Deposit $ by
O Cash(1 Check#i
Cut size after Perm. Patch
No.Cuts
Final Billing $
Amt. Due Payee $.
Amt. Due Town $
Applicant is responsible for contacting
the Police Dept. and C.B.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 1 AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR PERMITS AS OUTLINED IN THE
TOWN OF SOUTH WINDSOR'$STREET CUT PERMIT MANUAL.
Signed: Date:
Title: D.L.N
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
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