HomeMy WebLinkAboutRepair broken water service Street Cut P Perini - No. 2779 Town of South Windsor, CT
Date 07/27/1999
Street Excavation Permit
Expiration Date 07/26/200( ,,,
Descrip: REPAIR BROKEN �r+IA�I� `'`
Applicant Location
Name CONNECTICUT WATER COMP
N DRIVE
Addr. 25 NORTH ROAD
EAST WINDSOR CT 0605 � WATER
Phone (860)292-5552
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Applicant :agrees tourrli � aWinsor the amount of bond
required and to re i mb'ur '�' t ia�: _,ow ��� ' � o `°°for any expenses
incurred by the Town fog , i� n� , pal
�X 1r k �i i connection with this
permit and that app 1 scante , ami i i�r ark l 'abide by the rules and
regulations for permi3ts s o itl rr;: To* o_,f,ZoiUth Windsor' s Street
Cut Permit Manual
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* * PE MIT TO, KEpfi Sl T ,AT_ALL TIMES.
Issued by Title Z-c�Yl
Date Com l�e d ---_-
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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 / f-.
Describe fully nature of permit requested
Starting date Approx. time for completion
Call before you dig no. Traffic Services Control No.
Show sketch of proposed work or furnish "� To be filled out by Town of So Windsor
'
two copies of separate drawing ry Pavement Cut
Indicate North Prop. size of cut
No. cuts
Amt.of Deposit 8 by
—" ()Cash() Check#i
Cut size after Perm. Patch
v' No. Cuts
Final Billing $
Amt. Due Payee $
Amt. Due Town S
Applicant is responsible for c tacting
the Police Dept.and C.B.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 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'_�/L! 1 L� p �� A Date:- '7— d�-
Title: D.L.#/
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES