HomeMy WebLinkAboutDriveway Street Cut Permits 71 Steep Roa TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 3843
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Permit No. 3843 Town of South Windsor, CT
Date 09/03/2004 Street Excavation Permit
ira Ex` p tion Date 09/03/2005
' Descrip: :rt
Applicant ,•;::'.' :' fSA F N LR;F a't i on
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Name AIROLDI'S INC. , ?�STg ROAD r.
Addr. P 0 BOX 71 g .. s
SOUTH WINDSOR (71. <.0 0
Phone (860)289-3876
t o S�fil v 3" •. *h
Y Applicant agree, � tyr
� Ciunt of bond
required and to rembure. 32etown ofot33x3dsor 'crr` an expenses
incurred by the Town kr in ea � r " � �r
� s yyp Qk� neCtion with this
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t
permit and that apglict � am � fca� > 4' 1ae. by ttke rules and
regulations for peri4I�ta'.;<ci ? ., jut'.tk=`}Wa`Yel'sir's Street
Cut Permit Manual. y� w '+ .
* * PERMIT`'[0 BPy KE kT ON , a A" �S7I TIMPpS
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" APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm Phone No.
Address of Fi
Location of proposed work
Describe fully nature of permit request
Starting date Approx.time for completion 1
Call Before You Dig No Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North Prop. size of cut
No. cuts
td Amt.of Deposit$ 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 TOWN t
SOUTH WINDSOR FOR ANY EXPENSES INCURRED BY THE TOWN FOR MAINTENANCE OR REPAIR WORK IN CONNECTION WITH TF
PERMIT AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR PERMITS AS OUTLINED IN T
TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
SigneA. - Date:
Title-:.—(_ D.L.#•
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc