HomeMy WebLinkAboutDriveway Street Cut Permits 141 Hillside TOWN OF SOUTH WINDSOR INSPECTION REPORT
Peirmit No. 3852 7 1 .,,,W `""
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Permit No. 3852 Town of South Windsor, CT
Date 09/16/2004 Street Exc
avation Permit
Expiration Date 09/16/2005
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Name H. W. LEVACK CO.
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Addr. K:. :,.>_
49 MASCOLO ROAD':
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SOUTH WINDSOR C#is
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Phone 860 528 0131
Applicant agrees;: W'
� ':�t3 .Xi, zndpr>tlae`,<�:�no:unt of bond
required and to rei I�u
4 at `fap' .-''a. Y 'e3� rases
incurred by the Town'.. r„ma fL" race or,„repair wo.�� "fin C�ozin�hezi. n with this
permit and that applicant is farni zar �y�4+ ' za� �a?d by tie rules and
regulations for permits a ofal3inei ;; i jirof Seiuh;,.V1tid. or's Street
Cut Permit Manual. f'
* * PERMIT To .TIM£S.
Issued by — -- --- "� .-, t:l.e"-------------
Date Completed ---- — Inspected By
09/13/2004 MON 14:21 FAX 860 644 7280 South Windsor Town Hall 002/002
c.avKI "I'd rV-K 5 I KEET EXCAVATION PERMIT
• TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT Permit No.
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR,CT 06674
FEE $26.00 -
Name of Firm . LL�) (:�_ ,�' L.
Address of Firm j4 'hone No. /
Location of Proposed work -
Describe fully nature of permit requested
Starting date 1'1 y
Call Before You Dig No. Approx.time for completion
Traffic Services Control No.
Show sketch of proposed work or fumish
two coPles of separate drawing Indicate North 1 ectlo o filled Out
row_ n of Sau Windsor
Pavement Cut
No;cuts
EsL.Size of Penn.Patch(s)
Est Pvt Thickness in,
Est..Unit Price$
ArnL of Deposit$
Total Due$ by
.)Cash{ )Check
Permanent Patch No. Cuts
Size of Patch(s)
12— Final Billing
Amt.Due Payee
Arnt.Due Town
By
Applicant is responsible for contacting
the Police Dent and C.B.Y.D. 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 ANC EXPENSES INCURRED BY THE TOWN FOR MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND T HAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR
PERMITS AS OOUINED IN THE.TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
.Signed:
Title:
• Driver's License#:
PERMIT$BALL.BE KEPT ON JOBSITE AT ALL TIMES ---