HomeMy WebLinkAboutSanitary Lateral Street Cut Permits 40 S Permit No. TOWN OF SOUTH WINDSOR INSPECTION REPORT
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3630
Location 0040 SANDRA DRIVE Con�x,d<jtor COVEN G
Type Work Add::; a� INSTRUCTION CO.
NEW SAN LAT P O `'gO "
4 4 27
COVENTtYT 06238
Phon.e No ('8i0j 28 -OS.26
Date Insp Needed
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Time Insp Needed e \
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Inspected By
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Work in Progress
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Permit No. 3630 Town of South Windsor, CT
Date 11/14/2003 Street Excavation Permit
Expiration Date 11/13/2004
Descrip: TRENCH FOR SEWER :ILATER'"A,L
Applicant Loca.
Name COVEN CONSTRUCTION CO 434OSANDRA DRIVE
Addr. P.O. BOX 427
COVENTRY CT 063$ zeNEW SAN'LAT',
Phone (860)282-0526A.
Applicant agrees to i'ttrnisk the TSth Windsor the amount of bond
required and to re5mbukse the TOWS3 ` gt�t $gqsorvr a1�y expenses
incurred by the Town .mr'pTa,1i2t0nance' or Yepai or �rii can4.e,ct3on with this
permit and that appl:iearit zSail�ax ` a#d will aide .by 'he rules and
regulations for permits aS outlined xn thy;: �oizt' of South W;i:ndsor s Street
Cut Permit Manual.
* * PERMIT TC5 BE EFZ OT�7" 70$ S:ITE AT.: ALL TIMES.
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Issued by ----69 ----- _ TitleLtivl
Date Completed ----------------- Inspected By
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR Permit No.
• PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT 06074
4 FEE $25.00
Name of Firm Phone No :�2 I
Address of Firm P6 PJ O'k jd--
Location of proposed work
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Describe fully nature of permit requested
LAI
Starting date Approx.time for completion
Call Before You Dig No. a Q0 CU Traffic Services Control No.
Show sketch of proposed work or fumish This section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
Pavement Cut
No.cuts
Est.Size of Perm. Patch(s)
Est. Pvt.Thickness in.
/� Est. Unit Price$
S� 1 Amt.of Deposit$
Total Due$ by
( )Cash( )Check#
Permanent Patch
No. Cuts
Size of Patch(s)
Final Billing
Amt. Due Payee
Amt. Due Town
By
Applicant is responsible for contacting Date
the Police Dept.and C.B.Y.QL.
I AGREE TO FURNISH E TOWN OF SOUTH WINDSOR THE AMOUNT OF BOND REQUIRED AND TO REIMBURSE THE
TOWN OF SOUTH WIN SO FOR ANY EXPENSES INCURRED BY THE TOWN FOR MAINTENANCE OR REPAIR WORK IN
CONNECT ITH T S P RMIT AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR
PERMITS O TLINE IN E TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: ' Date: U 0
Title: Driver's License#:
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES