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HomeMy WebLinkAboutWater Street Cut Permits 812 Avery Stree 2372 Date 10/21/199`7 _ Town of South Windsor, C1- Expiration Date 10/21/ 1998 Street Excavation Permit DescriP : WATER MAIM Applicant Name SIMSCROFT ECHO FARMS Location Addr. P.O. BOX 581 ' C311 `AVER'Y SIMSBURY CT Phone (860)651-02L 116C170 Tvpe of. Wo, .WATER Applicant agrees to fernish� the ''Town of South in curred u i red and to reimburse 'the Town c�F South° W i n+ s r,.' incurred by the Town for maintenance ©r. r� ai � .ndsUr the amount of bond Permit and that a for any expenses pp � icant s `familiar Withpand ll in connection with this regulations for permits as Out i i ned. i n the Town, o,f outhe4�lbnds Cut Permit Marrua 3-. y the rules and Windsor's Street y * * PERM T To BE KEPT 0NSITE. AT ALL TIMES Issued by ���-'''� Tit"i e .�►";,, -� Date Completed — -------- ...__ Inspected By APPLICATION FOR OF SOUTH EXCAVATION PERMIT PUBLIC WORKS DEPARTMENT l TOWN HALL 1540 SULLIVAN AVENUE SOUTH WINDSOR, CT FEE $25.00 Name of Firm i� f C /o C- L.", / L/1/C' Phone No. (oTF- 7e741r Address of Firm . cr../ ih ad--7 -O Location of proposed work Describe fully nature of permit requested &-, ^Zn /Z Starting date Approx.time for completion Call before you dig no.47 2,10 Traffic Services Control No. Show sketch of proposed work or furnish To be filled out by Town of So. Windsor two copies of separate drawing Pavement Cut Indicate North Prop.size of cut No.cuts_�� Amt.of Deposit$ /c9G'20 by 2 O Cash O Check# ZS^ Zo Cut size after Perm. Patch No.Cuts Final Billing S Amt. Due Payee $ Amt. Due Town S Applicant is responsible for contacting 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. f Signed:_4Z.,, ��ivt���— Date: Title• ..�i� D.L.# PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES