HomeMy WebLinkAboutDriveway Street Cut Permits 129 Kent Lan TOWN OF SOUTH WINDSOR INSPECTION REPORT
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Permit No. 3667 Con trac,t.o.XwQ:UAL..�TY PAVING CO.
Location 0129 KENT LANE
A4,d�'ess, 90 S.T—Z0NG"'^R:QAD
Type Work DRIVEWAY " ``'S.OUfY€n ND„ ...
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-' Permit No. 3667 Town of South Windsor, CT
Date 04/13/2004 Street Excavation Permit
Expiration Date 04/13/2005
Descrip:
Applicant f•:: Loc`' ion
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Name QUALITY PAVING CO
Addr. 90 STRONG ROAD
SOUTH WINDSOR CT.,,?- 06079.`-';'gf'`+Wor
F3RSIF :WAY
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hon e 86 0 52 3 41 82
Applicant agree , .: k4; ;o":a' h e' aM., oUnt of bond
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required and to remY�rxfse ,C Ppwn (Sig"'S tzhrA.lsor fir', any expe-pses
incurred by the Towzi for''maant nanc •vp ep or i ;CcnjeiC dln with this
permit and that app'1 "c'aht>' ,:?> ;amY:: ` A`.' '>X# .� aFSa`d`E .:b : ..
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" y .Ghe rules and
regulations for permlFhi"as t� tined in th'e"flown 'd'fSaC:a7ijrisof s Street
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Cut Permit Manual
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PERMIT`;;I O': E'.;.IZEP:T 0 ''^'i7 ` 'x
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Date Completed
• APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
,ram r
Name of Firm , ��
Address of Firm Phone No.
Location of proposed work ?
De 'be full nature of permit request , c
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Starting date
Call Before You Dig No. C j c, 9 Approx.tim for com
Traffic Services Control No.
Show sketch of proposed work or furnish
two copies of separate drawing To be filled out by Tnw n nf c...tn WindSor
Indicate North 2
Pavement �fi
Prop. size of cut
No. cuts
Amt.of Deposit$ by
Cash()Check#
Cut size after Perm. Patch
f No. Cuts
r Final Billing$
l Amt. Due Payee$
Amt. Due Town$
Applicant is responsible for contacting b the Police De t. and C.B.Y.D. y 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 WINDSOR'S STREET CUT PERMIT MANUAL.
Signed:
Date:
Title: Ae.-/- --41
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D.L.#:
PERMIT SHALL BE KEPT ON]OBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc