HomeMy WebLinkAboutDriveway Street Cut Permits 169 Kelly Ro Permit No. 2381 Town of South Windsor , C;
Date 11 /05/1997 Street Excavation Permit
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Expiration Date 11/05/ 1998
Descrip:
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Applicant " Location
Name LEWIS PAVING CO. O469 KELLY ROAD
Addr . 52 BURNSIDE AVE
E, HARTFORD CT 0610E Type of Wor' 'DRIVEWAY
Phone (860)528-5204
Applicant agrees to furnish- the 'Town" of South Windsor the amount of bond
required and to reimburse thia',Town`,-of �Oth W}ndsor,,fo;r any expenses
incurred by the Town for,, mai htenaric`e or:��t"spa i r: wci�k `i n' connection with this
permit and that applicant is i'amil ar with and will ;abide by the rules and
regulations for permits as oojtlihed the Town 'o-P South Windsor ' s Street
Cut Permit Manual .
* PERMIT TO BE ..h1EPT' ON- JOB SITE AT ALL TIMES.
Issued byTitle �
s
Date Completed Inspected By
APPLICATION FOR STREET EXCAVATION PERMIT 423o l
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm eu 11 V041011--� e " Phone No. ����
Address of Firm fiq1&(/p-t. 1 o — yF
Location of proposed work LT-
Describe fully nature of permit requested /44w
Starting date n^ Approx.time for completion Qfqtj
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 /J&
No.cuts
L7Amt.of Deposit $ by
O Cash()Check#
Cut size after Perm. Patch
No.Cuts
Final Billing 8
/� Amt. Due Payee $
GAmt. Due Town $
Applicant is responsible for contacting
the Police Dept. and C.S.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 I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR PERMITS AS OUTLINED IN THE
TOWN OF SOUTH WIN R'S STREV CUT PERMIT MANUAL.
Signed Date: r
Title: D.L.N
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES