HomeMy WebLinkAboutReplace leaking water service Street Cut Permit No. 2243 Town of South Windsor , CT
Date 09/25/1996 Street Excavation Permit
t
Expiration Date 09/25/ 1997
De fcrip:
App i i Cant Location
Name g0;26 AHERN DRIVE
Addr .
Type -of Work WATER
Phone
Applicant agrees to furn�i h t�i►e Ti South Windsor the amount of bond
required and to reimburse .the Town of South W ndsor' for any expenses
incurred by the Town for maintena�tce or rep work `n connection with this
permit and that applicant Jk , familiar with and w7' 1 South eWbindsoe' su Street
les d
regulations for permits"'as:"a,utl ln,0114 i rti ,he -Tow o
Cut Permit Manual .
�',1� ERMIT T E "i<EPT QN JQB 'ST-TE AT TIMES.
T i t`�'e �
Issued by
Date Comp 1 e'ted Inspected By
- APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
! PUBLIC TOWN DEPARTMENT
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE 25.00
Name of Firm (.0 d Y Phone No. a7 67o?-
Address of Firm �� iY
Location of proposed work
Describe fully nature of permit requested
Starting date - & Approx.time for completion
Call before you dig no. Traffic Services Control No.
rQErz���
Show sketch of proposed work or furnish TO be felled -mt by Town Of SO Windsor
two copies of separate drawing Pavement Cut
Indicate North
Prop.size of cut
No.cuts
C Amt.of Deposit$ by
O Cash O Check#
Cut size after Perm. Patch
No.Cuts
Final Billing$
W 1A Amt. Due Payee $
t to pu-IL
n 5UV;Lt U1ILa e.4- i-()ad • Amt.Due Town$
Applicant is responsible for contacting
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 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:_f i9 t 0 �1r ) Date: 4 c�'T 6 �p
Title: (,( J/J J rr D.LJI
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES