HomeMy WebLinkAboutDriveway Street Cut Permits 23 Pleasant TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 3583 Cont", ,PAVING
Location 0023 PLEASANT VALLEY
Address JOHN,'F JUM3ELAS
Type Work DRIVEWAY
P O. BO3C �T 8
"sOUT�T �fIND'S(32 CT`"Q6074
Pne No6:84
Date Insp Needed -- Date> Ins �
Time Insp Needed Ts
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Work in Progress
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Permit No. 3583 Town of South Windsor, CT
• Date 09/04/2003 Street Excavation Permit
Expiration Date 09/03/2004
Descrip:
Applicant Lpcaa£4on
Name CUSTOM PAVING (Yq ;,PI,EPS UT VALLEY;
Addr. JOHN F JURGELAS ,
SOUTH WINDSOR CT 06074;" hype: WoA ARIVEwAY
Phone (860)528-2684
Applicant agrees ;to furnish :the Town q Sa�iGh WindsQT', the'`"amount of bond
required and to reimburse 't Town of 'I;Sp...." xl dsor for;,and' ;expenses
incurred by the Towni:for mainteri? �5 r1r work in :ecrnne ,C;isn with this
permit and that applicant ',` S x,familiar 'wYth 'an$ w� `1 ab',yt3e b the rules and
regulations for permits as:outl 'n c3 �f ;'. # TOout Winc'sx6r's Street
Cut Permit Manual.
* * PERMIT T,O'pBE KEPT ON c�RdB �uTT AT x1Ll TI:ME3.
4.
Issued by — / Title _ ---- —
Ins e'' 1
Date Completed "
— ------- 23 c't e d By
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OPSOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm ��-'�� 7 Phone No.
Address of Finn
Location of proposed work a A l �,�r,v> LJ�'>i g v
Describe fully nature of permit requested t
Starting date Approx.time for completion 7
Call Before You Dig No. Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North Prop.size of cut
No.cuts
Amt.of Deposit$ by
()Cash()Check#
Cut size after Perm. Patch
No. Cuts
Final Billing $
Amt. Due Payee$
Amt. Due Town$
Applicant is responsible for contacting by 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 TOWS! 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:
TT _ ,—�-�_� Date:—
Title: D.L.#•
PFERMIT SHALL BE KEPT ON]OBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc