HomeMy WebLinkAboutDriveway Street Cut Permits 208 Old Farm J00054 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 05/21/07
GIS ID: 66300208
FEE: 25.00
MUNIS APPLICATION# 200700709
>£ IRATION DATE:
OS/20/08
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NAME: AIROLDI S INC.
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D dam" IALAY D&JULIE AP O BOX 71
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APP
LICANT
CAN T AGREE
S
ST OF URNISH THE TO P
:�,..���M i, :F`B€)ND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANC:2E1'NSIH :II . T'` ? T `T( ?3�7 F(I MAINTENANCE OR REPAIR WO IN
CONNECTION WITH THIS PERMIT AND THE ,P? CAN ;5t4I. , kiL>'pBIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THEjj)TOWN OF'sov T; 1 2:' .I� CIJ PERSMIf MANUAL.
ISSUED 8V DA 1NSPECTED INSPECTED BY
5/21/200711:29AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: � ols CONTRACTOR:_ l CAI l
LOCATION: ADDRESS:
TYPE OF WORK: L Q
DATE INSP NEEDED: DATE INSP: -7 5�7
INSPECTED BY:
WORK IN
PROGRESS:
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-INPUT: �� DATE:---;L. ��
APPLICATION FOR STREET EXCAVATION PERMIT -700(j
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TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
TOWN HALL
1640 SULLIVAN AVENUE
SOUTH WINDSOR, CT 06074
FEE $25.00
Name of Firm ����� 5 �� - Phone No.
Address of Firm 1-y
Location of proposed work
Describe fully nature of permit requested
Starting date Approx. time for completion
Call Before You Dig No. Traffic Services Control No.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
Pavement Cut
No. cuts
Est. Size of Perm. Patch(s)
Est. Pvt.Thickness in.
Est. Unit Price$
Amt. of Deposit$
Total Due$ by
( ) Cash( )Check#
�S
Permanent Patch
No. Cuts
a� Size of Patch(s)
Final Billing
Amt. Due Payee
Amt. Due Town
By
Applicant is responsible for contacting Date
the Police Dept. and C.B.Y.D.
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 LINED IN THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL,
Signed: Date:
Title: Driver's License#:
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES