HomeMy WebLinkAboutMiscellaneous Street Cut Permits 175 Whe r ,.
TOWN OF SOUTH WINDSOR INSPECTION REPORT
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Permit No. 3517 Contra`d6or HOMEOWNER.
Location 0175 W'HEAMUR ROAD Addres:r SAME "AS; AB6UE„
Type Work MISCELLAN ,AME AS' ABOVE
QUTH WINDSOR CT "06074
ghoiie;No (;Ck�O)'0,C1'0 000;0
Date Insp Needed "Date I> }� �
Time Insp Needed
----- "Time
Inspected By2��,r.,y .
Work in Progress
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_Input Date °,
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Permit No. 3517 Town of South Windsor, CT
Date 06/02/2003 Street Excavation Permit
Expiration Date 06/01/2004
Descrip: SIDEWALK
Applicant Locat2bn
Name HOMEOWNER 0<t 75 WHEELER.,,.RQAD
Addr. SAME AS ABOVE
SOUTH WINDSOR CT 06074 $ rpe q oxk:.,.bHZSII ELAN
Phone (000)000-0000
Applicant agrees to furfflsh`the 86uEh Windsor ;:the amount of bond
required and to reimb1r:se tkze TocJxl crf ou h PTlndsor;, fnr any 'eiKpenses
incurred by the Town for tatenance 'or"rbpair Work;>in 'corinectin with a this
permit and that appl3,c.ant i.satrll>kext ax#d wild :ablde,by the rules and
regulations for permits as.., outlined iti the TpWp of Sptl�h Windsor's Street
Cut Permit Manual.
* *% O , TTMES.PERMIT T .
Issued by ��=✓�= — _ Title
Date Completed Inspected By 9 _K i&
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm Phone No.
Address of Firm
Location of proposed work L -
Describe fully nature of permit requested
Starting date % � Approx.time for completion ;
Call Before You Dig N Traffic Services Control No.
Show sketch of proposed work or furnish
two copies of separate drawing To be filled out by Town of South Windsor
Pavement Cut
Indicate North Prop. size of cut
I No. cuts
C ` Amt. of Deposit$ by
)Cash )Check#
1(c / Cut size after Perm. Patch
` 1 -
No. Cuts
.17 1 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 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: E..1
Title: Las ���
D.L.#:_
1
PERMIT SHALL BE KEPT ON]OBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc