HomeMy WebLinkAbout21 Wendy DrAPPLICATION FOR STREET EXCAVATION PERMIT
Appl. No. TOWN OF SOUTH WINDSOR PUBLIC WORKS DEPARTMENT Permit No.
TOWN HALL 1540 SULLIVAN AVENUE SOUTH WINDSOR, CT 06074 FEE $50.00
Name of Firm rr', Qom, �J v� Phone
Address of Firm r,Or(�,4. Zip Code c!_
Location of proposed work'
Describe fully nature of permit requested
Starting date V'1 I� I �� Call Before You Dig No Zak I �[0
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A PRELIMINARY ESTIMATE. THE
APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE PERMANENT PATCH AND CURB REPLACEMENT, INCLUDING ANY
INCREASES IN PATCH AREA, CURB LENGTH, TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS
TYPICALLY COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Check Applicable: El No Pavement, Curb or Sidewalk Cut ❑ Pavement Cut ❑ Curb Cut ❑ Sidewalk Cut
L7 Existing Driveway, No Changes ❑ Proposed Driveway Widening ❑ Proposed New Driveway
Water Supply: ❑ Public Water []Well Sewage Service: ❑ Public Sewer ❑ Septic
Show sketch of proposed work or furnish Indicate North
two copies of separate drawing
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1-6
6- N -� I' L�"t'z�
DRIVEWAYS must be aft or more from the property line per
section 2.17 of the zoning regulations
Applicant is responsible for contacting the Police Dept. and C.B.Y.D
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
This section to be filled out by Town
No. cuts
Est. Patch Sizes) sf
Est. Pvt. Thickness in.
Est. Patch Unit Price $ /sf
Est. Patch Cost $
Est. Curb Replacement ft
Est. Curb Unit Price $
ttt
Est. Curb Cost $
Est. Sidewalk Replacement
sf
Est. Sidewalk Unit Price
Est. Sidewalk Cost $
Est. Traffic Hours
hr
Est. Traffic Unit Cost $
/hr
Est. Traffic Control $_
Amt. of Deposit $ _
Total Due $
( ) Cash ( ) Check #
Paid By
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 REGULAT'�i N($�JFOR PERMITS AS OUTLINED IN THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MA
UAL.
Signed: � C f ry ( Print Name CJhoL� 11-'1 1 1 D ( -I Date:
Engineering/permits/Street Excavation Permit 2017