HomeMy WebLinkAboutDriveway Street Cut Permits 12 Pine Knob TOWN OF SOUTH WINDSOR INSPECTION REPORT
Flfrmit No. 3988 ,Cnntrytp: E.G`;'PA•.
Location 0012 PINE KNOB DRIVE k.
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Type Work DRIVEWAY ST
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Permit No. 3988 «_:::_>.`>;_::.<'_', Town of South Windsor, CT
Date 05/27/2005 ""` ,.:.„ Street Exc
avation Permit
Expiration Date 05/ /
Descri y2:>>
p: CK 3120 50.00
Applicantk'
`s......a`f n
Name E.C.PAVING
%;NE
Addr. 139 WE THERELL 'T'" g.
3.
MAN CHEST
Wos� D�2'TI?�
Phone9834
860 647- a
,.
Applicant agree tom;, id-rG .-C, 6 s I Wi']'o it � mount of bond
required and to reimbu X. tk7 TocSfax ea Som a' s°ox `,fir any expenses
incurred b the Tower a
'.:• ina t
rk'r? ;.:;� orine' 'ion
Y with this
permit and that appli cant, z:S. ,aft 'y 3G ;>;a%?r3;�c'z'T'�`.:ab:3d .. l.:ii:' rules and
regulations for permits 8s outlined of Scfuh kTixlcisor's Street
Cut Permit Manual.
* * PERMIT TO 'hz ,sI MES.
Issued by
„
[/
Date Completed ----- Inspected By ---
APPLICATION FOR STREET EXCAVATION PERMIT 270-8
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT Permit No.
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR,CT 06074
FEE $25.00
Name of Firm - Pav L ' L��
Address of Firm q Phone II
ck
Location of proposed work
Describe fully nature of permit requested o ve 5+1 c).ir,v cw U-�
Starting date
ADt']Pn_Y fimn for..., t a
Call Before You Dig No.-(�UZ�. ��OIS3 3 Tp� time
fo ..o pletio �
Traffic Services Control No.
Show sketch of proposed work or famish
two copies of separate drawing Indicate North This on to be fill out by
Town of South Windsor
Pavement Cut
0 No.cuts
Est.Size of Perm.PaWs)
Est.Pvt.Thickness in.
Est..Unit Price$
Amt.of Deposit$
Total Due$ by
( )Cash( )Check#
Permanent Patch
No. Cuts
1 3 Size of Patch(s)
Final Billing
a
Amt.Due Payee
a
Amt.Due Town
By
Applicant Is responsible for contacting
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 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: P
Date:
Title:
Driver's License#:
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES