HomeMy WebLinkAboutWater Street Cut Permits 741 Avery Stree Pe
670
o 299 Town of South Windsor, CT
Date" . 05/03/1999 Street Excavation Permit m t
Expiration Date 05/02/2000
Descrip:
Applicant '
Location
Name STATE LINE SEWER & CO1 ,T CO 074 AJEY'" STREET
Addr. 238 SHAKER ROAD _ f
ENFIELD CT 06082 �a= of{ l�r ` WATER
Phone (860)749-6176
4
Applicant agrees toohtehthetfrdor the amount of bond
required and to re i mbl"U S � ` -- -
#4th �a �� `� r any expenses
incurred b the Town or � . .lbide
connection with this
Yf enartC� epai
permit and that app 1 � g � by the rules and
an
regulations for permi see f� th Windsor ' s Street
Cut Permit Manual .
41_ X g'.� 3
* PERMIT T t3 � IPTf; J� LL TIMES.
Issued by
Date Cample ed Inspected By `
I
TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 2670 Contractor STATE LINE SEWER & CONST CO
Location 0741 AVERY STREET Address 238 SHAKER ROAD
Type Work WATER
ENFIELD CT 06082
Phone No. (860)749-6176
Date Insp Needed
Date Insp' 9
Time Insp Needed
Time .Insp'.
Inspected B
Y
Work in Progress
.LOAM/2>ri U/J?t'.�f3C� /7/7L�13 s
Input Date S-J-y5
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE All
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm •Vt ;,�/��' Phone No•
Address of Firm a3 sr � o t
Location of proposed work- ue-r
Describe fully nature of permit requested v rc -40
Starting dote ♦ Approx.time for completion
Call Before You;Dig o. 6 Traffic Services Control No.
Show;sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
Pavement Cud
Indicate North Prop.size of cut X Jc-� 3osg9r)
No.cuts
AMt.of Deposit
w \j
{`)Cash(heck# 11'3d�
Cut size after Penn. Patch
�j No. Cuts
�t(�! Final Billing$
cc,j Amt. Due Payee$
Amt. Due Town$
Applicant is responsible for contacting by date
the Police Dept.and C.B.Y.D.
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 SOUT WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: �--� Date:
Title: D.L.#:
PERMIT SHALL BE KEPT ON 306SITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc