HomeMy WebLinkAboutDriveway Street Cut Permits 715 Avery St Perm-sIA
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APPI - cant agrees t-o furnish. the Town of South Windsor the, amourt of bonci e U 44red and t,�, re-imourse the Town of South Winasor for an'
in urred ;-,,y he y i;-:,x p e,,,s e S
4 Tc�wn for maintenance or repair work :.-,onnect-;on with, �his
pe-Mlt arl"j t�'a' aPPlicant is familiar With and will abide Key t '
re 3 i-4 IEI-Iions for p,,��-rjts as out-fined in the Towry of Sout�j Wir he ruies a r.,C,
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ki 11 1-UD BE, KEPT CN JOB SITE AT ALL TIME-s .
Issued bv
T-,;t 1 e
Date Compiete'd", inspected
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm Phone N CS60 GC1,25 a�
Address of Firm
Location of proposed work
Describe fully nature of permit requested
Starting date Approx.time for completion
Call Before You Dig No. Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North � �J Prop. size of cut
a5� No. cuts
Amt. of Deposit$ by
()Cash ()Check#
Cut size after Perm. Patch
No. Cuts
Final Billing $
Amt. Due Payee$
Amt. Due Town$
Applicant is responsible for contacting by
the Police Dept. and C.B.Y.D. 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: Date:_ ��I
Title: 9
PERMIT SHALL BE KEPT ON]OBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc