HomeMy WebLinkAboutSanitary Lateral Street Cut Permits 195 PermitIt No. 2444 Town of South Windsor, CT
Date 06/05/1998 Street Excavation Permit
Expiration Date 06/05/1999
Descrip: CK 113533 1202 . 40, CASH 25 . 00
Applicant kN . Location
e Ina
Name YANCEY {
AVJSXJ DRIVE
Addr. 27 R COMMERCE STREET , 5N� �
GLASTONBURY CT 0603,Epe;olf
��" INEW SAN LAT
Phone {860)633-0423 �r.
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�Rws
Applicant agrees tc � urKi � hey � i ,4or the amount of bond
required and to reimb r eii err bw h pt r or any expenses
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incurred by the Town fc�.t �,g,,t ,#19n n" connection with this
permit and that appl icyand1eide by the rules and
regulations for permits .as 9V1 �� ,,, � ���, o ith Windsor' s Street
Cut Permit Manual '
* PERMIT TC �,,B = i? �� ��. T L TIMES.
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Issued by
Date Completed "inspected By
I
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm �Gj � � �n 5 fry� �oe Phone No.
Address of Firm
Location of proposed work /yrs� ,��jzq`✓S�s, L7
Describe fully nature of permit requested �.SCk/G�,
*747
Starting date Approx.time for completion
Call before you dig no. p�„� Csf ;�`, Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Towlll of So Windsor
two copies of separate drawing Pavement Cut
Indicate North f
Prop. size of cut yd
No.cuts_G_
' Amt. of Deposit$
() Cash() Check#
��`" �- �r• � Cut size after Perm. Patch
No.Cuts
Final Billing $ o ve la l^d
Amt. Due Payee $ o� 4 0
Amt. Due Town $
Applicant is responsible for contacting
the Police Dept. and C.B.Y.D. by date
I AGREE TO FURNISH TO THE TOWN OF SOUTH WINDSOR THE AMOUNT OF BOND REQUIRED AND TO RQMBURSE 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.
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Signed:_ D Date:
Title: G h' C.G�HII���1'�l` o® .
D.L.#
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
• 10 NN Se
-Afi
Opso� ?d 1540 SULLIVAN AVENUE • SOUTH WINDSOR, CT 06074
°SOR-CO TELEPHONE (860) 644-2511
June 20, 2006
La Cava Construction Company Certified Mail
185 Silas Deane Hwy— Suite 1
Wethersfield, CT 06109
Re: Street Excavation Permanent Patch Fees
Permit #2444, 195 Krawski Drive
To Whom It May Concern:
When the Town of South Windsor issued the above referenced permit to your
organization, it collected $1202.40 for a permanent patch deposit based on available
estimates at that time. The roadway was overlaid therefore, the deposit of$1202.40 is
being refunded to you.
Permit Address Deposit Cost Refund
2444 195 Krawski Drive $1202.40 overlaid $1202.40
If you have any questions, please contact me at (860) 644-2511, extension 244.
Sincerely,
Jeffrey Dolittle, P.E.
Town Engineer
cc: Melanie D. Crucitti, Director of Finance
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REFUND OF DEPOSIT REQUEST FORM
STREET EXCAVATION PERMIT
Request Date:
Issue Refund in the amount of
From Account# 001-0300-0205-059
To:
Permitee: Lcv- G-va
Address %,rD 73 l (cts big(an49-
LZL-trey:, 5 ��`P1 d, CT N,6 l C)
Permit t 4H
Number
Location
Number Location
Number Location
Number Location
Number Location
Submitted By: Q"AAA
Narne Date
Check Issued:
Number Date
Processed by Finance
Name Date
S:'ENGINEERIFORMS OMfl FomnTatch Refund Fotm.doc