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HomeMy WebLinkAboutExcavate in ROW for water use Street Cut'ermi t Nc 2404 Town of South Windsor , r late 02/2,7/ 1998 Street Excavation Permit :xpiration gate 02/27/ 1999 lescrip: WATER SERVICE GONNPCTION App I i cant L�>c-at�i ors �.j ame TED RUSICk GONSTRUCTIpN ` 03,8 A 8BE fit©AD ddr. 1919 ,BOSTON POST RD: GUILFORD CT 06437 Type of,' Work, WATER hone {8(50)669-'2 133 Applicant agrees to fiunn Sh the T.cawrt of Scutt 4J r nd,sz�r the amount of bond required and to reimburs0 the. Town of 6outh W'`ndsor fur any expenses incurred by the Town for rrrr-t'ntenance o"r° r'epair "w rk fn' (connection with this permi t and that. app I r cant is fami''l i ar with and w1 l l abide by the rules and regu at ions for permits as ou`tl.ined in the Town .of South Windsor ' s Street Cu-: Permit Manual . i * * PERMIT TO Tsc `'KE:f-'T Gil- JOG SITt ,AJ ALL TIMES . Issued b Date Como Ieted Inspected 8 -# 2¢0¢ APPLICATION FOR STREET EXCAVATION PERMIT TOWN OF SOUTH WINDSOR PUBLIC WORKS DEPARTMENT TOWN HALL 1540 SULLIVAN AVENUE SOUTH WINDSOR, CT FEE $25.00 Name of Firm � 6 �GLc . G� - ���T Phone Address of Firm Location of proposed work Describe fully nature of permit requested 1 e Starting date Approx.time for completion Call before you dig no. Q Traffic Services Control No. Show sketch of proposed work or furnish To be Fred Out by Town of So. Windsor two copies of separate drawing Pavement Cut Indicate North Prop.size of cut No.cuts Amt.of Deposit t by O Cash()Check tl _ Cut size after Perm. Patch �L No.Cuts Feral Billing$ - Amt.Due Payee 0 4 Applicant is responsible for contacting Amt.Due Town the Police Dept.and C.S.Y.D. by* date 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 1 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: —r2r7' :R.4- — Title D.L.#f PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES C.ir c-k. w/-T� VA, P.n,,D /m_* f,vsupAje eef j'a'►i