HomeMy WebLinkAboutWater main Street Cut Permit Abbe Road APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
A4� Bond Required PUBLIC WO
OOWN DEPARTMENT P
Amt. on File Permit ' ?
Date of Expiration 1540 SULLIVAN AVENUE Date a �-
w Ins. on File OYes O No SOUTH WINDSOR CT
Expiration Date FEE $25.00 ' Permit Expires _8
Name of Firm 't'• CAAAV'
Address of Firm Z Phone No.
Location of proposed work
Describe fully nature of permit requested .00 1. Q ► ---� �\�
Starting date
Call before you dig No. ��0/ -s-3 Approx. time for completion w e PC
Traffic Services Control No.
Show sketch of proposed work or furnish To o be fiped out by Town of South VWrKb"
two copies of separate drawing
OPavement Cut
Indicate North n ,
Prop. size of cut + v y
No. cuts
Amt. of Deposit $ i by
W Aj k) VV A-rm t 4) I S Its! "U_s/13(..G Re ( ) Cash ( ) Check #
P6# a► /V 1"C..A,-'- U)4rW 1Xj6 A_) A-S Cut size after Perm Patch
�/fij �t✓ Q Nam . No. Cuts
Final Billing $
Amt. Due Payee $ _
Applicant.is responsible for agntacting Amt. Due Town $
the Police Dept. and C.B.Y.D.
by date
I agree to funish to the Town of South Windsor the amount of bond required and to reimburse the Town of South Windsor
for any expenses incurred y the Town for maintenance or repair work in connection with this permit and that I am
familiar with and will abi by the rules and regulations for permits as outlined in the Town of South Windsor's Street Cut Permit Manual.
A
9
Signed: Title: 5A
Date: =
PEFWT ITT ON AT ALL TIMES
APPROVED: DATE: / /J
ENGINEER
FOR INSPECTOR: Date work started Date Completed
Signed Date
WHITE - PERMIT
PINK ST. SERVICES
YELLOW - ENGINEERING -
GOLDENROD - FINANCE
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