HomeMy WebLinkAboutDriveway Street Cut Permits 185 Pine Tre T TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 3802 Conk,rax-L,*t'br""QTATT�Y.,: AVING CO.
Location 0185 PINE TREE LANE 7�ddre f^;
a g,, 194,E.,O-NAIT�,:45TREET
Type Work DRIVEWAY »
EAST 1IIO�2'"'G;z 06088
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Permit No. 3802 Town of South Windsor, CT
Date 07/15/2004 My
Street Excavation Permit
Expiration Date 07/15/2005
Desc i r p:
Applicant
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Name QUALITY PAVING qO.
8r�tiagr�':�:NE 'r:��� :7;A'iJE
Addr. 194 S. MAI
EAST WI ND SOR G`T 'ti
Phone
- 8 2 41 523 860 "'� ) ,..r..
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Applicant agree:. to":frs' ``'t.he.:.:
' ,fi.•...Wind r- e":a. Cunt of bond
re
quired ui red and to rei`
bur'` ff
incurred by the Towl':i.Ur. riASht �nce. ..a..z:.re zva<:1's' A'G 'e':•::;,,rf: p, :r�, ;.,x. '.: .ann ctn with this
permit and that a 11,can P pp t .: ? jl1:,asb ,ce.>" Y> t: e rules and
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regulations for permif s as** o�,.Cl;�ned';><� k.` " s;�q; y. of ��:� W�>ridsor s Street
Cut Permit Manual.
* * PERMIT TO hZ`:K).E' ON:...JO `BT1E AT"` L'li""':TI. .8S.
Issued by .9
Date Completed _-- Inspected By
t
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
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Name of Firm > r �'C Phone No.
Address of Firm
Location of proposed work e
Describe fully n re of_permit requested l
Z4L `
Starting date 16, 77-17 Approx.time for completion
Call Before YoeDigAo. Z o J S4 Z 96 // Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North Prop.size of cut
Z No.cuts
Amt.of Deposit$ by
q ()Cash()Check#
/ Cut size after Penn. Patch
No. Cuts
Final Billing$
Amt. Due Payee$
Amt. Due Town$
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Applicant is responsible for conta 'ng by-.--____ date
the Police Dept. and C.B.Y.D. t
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.
1131,
Signed: Date:
Title:. — D.L.#•
PERMIT SHALL BE KEPT ON 70BSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc