HomeMy WebLinkAboutDriveway Street Cut Permits 39 Saginaw S TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No 4037
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Type Work DRIVEWAY art''"
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Date
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Permit No. 4037 Town of South Windsor, CT
Date 07/15/2005 Street Excavation Permit
Expiration Date 07/15/2006
Descrip:
Applicant
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Name AIROLDI'S INC. '::>a<<. Qf3 5F37,W STiEE
Addr. P 0 BOX 71
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SOUTH WINDSORT 0$01`4 fatp 'Jo Wo-r RS�FPWAY.
Phone (860)289-3876
Applicant agreed to. h Wincls.Q the amount of bond
required and to re3mbur the'`Town f �-pkt 1t#c sor ctr ax y'. xpenses
incurred by the TOWn fOr`ttia i e`zr �X :ram .ram W k cgnn :t. with thispermit and that app # !aut<'" '''f_amiliar with ,.andwy'a;rel;ei;:..:tXie rules and
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regulations for perm}ts a� ou� �n®d .etsxi Qf Sbut Fi Wind3or's Street
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Cut Permit Manual.
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PERMIT KE -�JN bl 6kITS AT"ALA ME
Issued byiGe
Date Completed
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APPLICATION FOR STREET EXCA
VATION PERMIT 03�
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
\ � � C Phone No.
Name of Firm \
Address of Firm
Location of proposed work —
Describe fully nature of permit requested qMl
Starting date Approx.time for completion r —
Call Before You Dig No Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North Prop. size of cut
No.cuts
Amt. of Deposit$ by
C ()Cash ()Check#
�l 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 TOWN
SOUTH WINDSOR FOR ANY EXPENSES INCURRED BY THE TOWN FOR MAINTENANCE OR REPAIR WORK IN CONNECTION WITH T
PERMIT AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR PERMITS AS OUTLINED IN '
TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed:
Date:
Title: c ���� 1•__ D.L.#:
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc