HomeMy WebLinkAboutDriveway Street Cut Permits 87 Juniper L TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 4029 Con:t`rac,tox QUA7,,ZTY""RAVING CO.
Location 0087 JUNIPER LANE ;<!
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Type Work DRIVEWAY '>'
REET
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Permit No. 4029 Town of South Windsor, CT
Date 07/08/2005 Street Excavation Permit
Expiration / /Date 0 7 0 8 2 0 0 6
Descrip: CK 4626 - 2 PERM. PS
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Name QUALITY PAVING;'CO. ;j
Addr. 194 S. MAIN ST2E.$i:: t>'s> '• >:k` ;::.
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PERMIT Td<',.B$ +,O1 "°if:(l$•'uf 1" A "' T7NIES.
Issued by
Date Completed Inspected B
APPLICATION FOR STREET EXCAVATION PERMIT _
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT Permit No.
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT 06074
FEE $25.00
Name of Firm �/ ' .
Address of Firm Phone No.
Location of proposed work
Describe fully nature of permit requested
Starting date
Call Before You Dig No. Approx. time for completion
Traffic Services Control No.
Show sketch of proposed work or fu sh
two copies of separate drawing Indicate North This section to be filled out b Town of South Windsor
\\ % Pavement Cut
% No.cuts
1/ Est.Size of Perm. Patch(s)
l
Est. Pvt.Thickness in.
Est. Unit Price$
Amt. of Deposit$
Total Due$ by
( )Cash( )Check#
Permanent Patch
i
No. Cuts/ Size of Patch(s)
I Final Billing
i $
Amt. Due Payee
Amt. Due Town
Applicant is responsible for contacting By
the Police De t.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 ANY EXPENSES INCURRED BY THE TOWN FOR MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS RMIT AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR
PERMITS AS O T IN N T E OWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed:
Date:, ds
Title:
Driver's License#:
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES