HomeMy WebLinkAboutDriveway Street Cut Permits 53 Hayes Roa Iv.
TOWN OF SOUTH WINDSOR INSPECTION REPORT
{Permit No. 3660 Ca,�3:t'Yactq�' CUSTOM"SAVING
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Permit No. 3660 Town of South Windsor, CT
Date 04/02/2004 Street Excavation Permit
Expiration Date 04/02/2005
Descrip:
Applicant ,,
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Name CUSTOM PAVING """"""'•"' """"
'E1#p"5,3 HAYES Ft:4„�D.
Addr. JOHN F JU %d "RGELA s' :: 'f`r<
SO
UTH WIND SO R .CT.
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Phone
(860)528 2684 .
Ap
plicant PP t agrees the
4h WinS:a'xh ,unt of bond
required an ::
q d to re' [rbLt .:,. .k.eT'i'� .•? "o.Jtla::::, :efi
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incurred b the Totin..: r: :Y nan6 or repair rororl 61n ect on with this
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permit and that appii' nt asY:'fa '�3 vr� lbile„'by the rules and
regulations for permz.ts as'° G1in'e:d ri C: e.> c`' ''"ofi Eh`?Il .ncY'sor s Street
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ermit Manual.
t * PERMIT TO::cBE: T:I S
Issued b
,i
Date Completed --------------- Inspected By _„� j _�,
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APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm � -b►-� �(� U Phone No. (on -- ni
Address of Firm p.
Location of proposed work _s 3 '
Describe fully nature of permit requested v
Starting date L2111 s7- 0 y Approx.time for completion ;' - 75 C, y y
Call Before You Dig No. --7-'ll r`2 d 2-a 3 Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out br Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North Prop. size of cut
No. cuts
Amt. of Deposit$ by
( )Cash ( )Check#
( .� t Cut size after Penn. Patch
t
No. Cuts
Final Billing $
_ _ry Amt. Due Payee$
1t Amt. Due Town $
Applicant is responsible for contacting by dare
the Police Dept. and C B Y D I
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: .w�,rLc .., Date: > f J
Title:_ PT 5 D.L.#: 0 3 `9 /k-3 S
PERMIT SHALL BE KEPT ON]OBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc