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TOWN OF dTH WINDSOR INSPECTION REPORT
Permit No. 3336 Contractor AIROLDI ' S INC .
Location Address 41 ZINFANDEL CIRCLE
Type Work A TOLLAND CT 06084
. .' one No. (860 )896-0401
Date Insp Needed '" sp
Time Insp Needed i
Inspected By J
Work in Progress
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~V ..... Date
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Pgzr " ,tNo. 3336 Town of South Windsor, CT
Da 06/28/2002 Street Excavation Permit
expiration Date 06/28/2003
Descrip:
Applicant Location
Name AIROLDI 'S INC. SA C MEADOW R
Addr. 41 ZI'NFANDEL CIRCLE 1
TOLLAND CT 06084 DRIVEWAY
Phone (860)896-0401 "
Applicant agrees `" h or the amount of bond
required and to reim Uro o o h f r any expenses
incurred by the Town if a epa connection with this
permit and that appl ca am an r ide by the rules and
regulations for permi t th Windsor's Street
Cut Permit Manual .
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* PERMITS L TIMES.
Issued by Z "•. P.�_l
Date Completed _ nspected By
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm JAI ro )cA I �S _Ln L Phone No. 7
Address of Firm P, O n,,, '71 . So Tk lAjj0ol r ,-
Location of proposed work /17S SC0-o-, ; aa 4c�
Describe fully nature of permit requested i n rt Locc-,
Starting date '7 i o�) ro>c Approx.time for completion Jv& E 4 a Oo a nPrll�e
Cali Before You Dig No. O 90 8 Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North e 020 Prop. size of cut
No. cuts
l0 X tP
Amt. of Deposit$ by
LO( ()Cash ()Check#
U Cut size after Perm. Patch
No. Cuts
Final Billing $
020
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 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: } Date: 2—
Title:— D.L.#:
PERMIT SHALL BE KEPT ON 30BSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc