HomeMy WebLinkAbout66 Foster RdAPPLICATION FOR STREET EXCAVATION PERMIT
Appl. No. TOWN OF SOUTH WINDSOR PUBLIC WORKS DEPARTMENT Permit No.
/Lt1 uTOWN �jHA�LL 1540 SULLIVAN AVENUE SOUTH WINDSOR, CT 06074 FEE $50.00
Name of Firm I I. �Uk4�li L`C— Phone No.
Address of Firm Ct . Zip Code C^EO.7 U
Location of proposed work Cc G
Describe fully nature of permit requested : Ct —
Starting date 41- I l- Call Before You Dig No f 4011
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 WIT IN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Check Applicable: No Pavement, Curb or Sidewalk Cut Pavement Cut ❑ Curb Cut ❑ Sidewalk Cut
❑ Existing Driveway, No Changes LEIeProposed 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
0
4-1t-�Lcf
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 Size(s)
sf
Est. Pvt. Thickness in.
Est. Patch Unit Price $
(sf
Est. Patch Cost $
Est. Curb Replacement
ft
Est. Curb Unit Price $
/ft
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 REGULATIONS FOR PERMITS AS OUTLINED IN THE TOWN OF SOUTH WINDSOR'SLSTREET CUT PERMIT MANU1A�.
Signed: 1 ' �b S1' P'k,k-I �" —t Print Name k i '`��I I� I Iv' i Date:
Engineering/permits/Street Excavation Permit 2017