HomeMy WebLinkAboutDriveway Street Cut Permits 785 Pleasant 1' TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 3551 Cont,rActdr"CVS'TOM.;;,;RAVING
Location 0785 PLEASANT VALLEY Ad'ares: : `J€ JOHN.,::"F;,::J.URGE,LAS
Type Work DRIVEWAY
�JL7T�i WINDSOR CT "06074
Ph'ane528-" 684
Date Insp Needed
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Time Insp Needed
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Permit No. 3551 Town of South Windsor, CT
Date 07/21/2003 Street Excavation Permit
Expiration Date 07/20/2004
Descrip:
Applicant �ocataLon
p.
Name CUSTOM PAVING 678$. PLEASANT VALLEY
Addr. JOHN F JURGELAS '
SOUTH WINDSOR CT 06074se. of :btk pgIVENrp�,"
Phone (860)528-2684
ji
Applicant agrees to fUr1%1sWY the Tawn of 'youth Wind o:r the
:,,amount of bond
required and to reiinburso;. the Town South: T�Y1s3sor for' any ::expenses
incurred by the Town for mantenance`or e k pair wor zri:
i r conrjecti:bn with this
permit and that appli CaInIt is fzimil�a i i w "Tl ab'i'de by 'tie rules and
regulations for permits as ou Lined t77e,:T� k1 of South WipdAor l s Street
Cut Permit Manual.
* * PERMIT TO :BE kk ON''3QB, a"I:PB T;:ALS ,.TIME'$.
Issued by Title
Date Completed _ Inspected By �j�
APPLICATION FOR STREET EXCAVATION PE ���
PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS.DEPARTMENT
TOWN HALL
v 1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm 411 (il V Phone No. ��b_I
Address of Firm_ �,O, ��D 1
Location of proposed work `7 R lea <,, -4— \/ p C, 7�y
Describe fully nature of permit requested L&S
Starting date a t 0 Approx.time for Completion
Call Before You Dig No. _c CQ Traffic Selvices.COntrol No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
WPavement Cut
Indicate North Prop.size of cut
No.cuts
Amt.of Deposit$ by
Cash()Check#
C �`J Cut size after Perm. Patch
No. Cuts
Final Billing$
Amt.Due Payee$
C Amt.Due Town$
Applicant is responsible ntacting J 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 TOWN OF
SOUTH WINDSOR.FOR ANY EXPENSES INCURRED BY THE TOWN FOR MAINTENANCE OR REPAIR WORK IN CONNECTION WITH THIS
PERMIT AND THAT JAM 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: 6 3
Date:_ - (/ 2 1/
Tide:
PERMIT SHALL BE KEPT ON 70BSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permitdoc