HomeMy WebLinkAboutSanitary Sewer Street Cut Permits Avery Town of, South Windsor , CT
erm,7t, Nc1• 2352 Street Excavation Permit
Eite 09/23/ 1997
xpiration Date 09/23/ 1998 �:
escr ip: CK3962 IS FORPATCH FEry IS FOR PERMIT FEE
CK.�. �98
Location
Applicant
lame SIMSCROFT ECHO FARMS AYERY $T ,AND CHANDLER DRIVE
,ddr . P .U. BOX 581 Type of Work SAN MAIN
SIMSBURY CT 06070
'hone (860 )651-0231
ant agrees to furn4sh.,'tha Town of Outh W�nda.r r any ee�pen sesmount Of bond
Applicant 3
required and to re i�Y�bu rye the Town of5c�uth Winc�.r wit
incurred by the Town for rria ntenance Qwi nGhpand wOi l ab i denby 'trie�l rules and
permit and that applicant .t5" famlia
regulati'ans for permits 'as ,qutlined ire the Town o� south Windse��' s Street
Cut Permit Manual .
* * IPERMIT TO BE KEPT_ON JOB aITE 'AT TIMES.
Title
Issued by
' Inspected BY --
Date Comp l a tdd
4
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL Z 3S
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE 25.00
Name of Firm i� ✓pY4T �C �`•�sM-,� :/G Phone No.
Address of Firm 6 s r �*S ✓ �•'— 7
Location of proposed work
r .
Describe fully nature of permit requested ,
Starting date Approx.time for completion
Call before you dig no. Traffic Services Control No.
Show sketch of proposed.work or furnish To be filled out by Town of So Windsor
two copies of separate drawing Pavement Cut
Indicate North
Prep.size of cut
No.cuts_
Amt.of Deposit$ ( f by
()Cash Check# 394 Z Z 39c
Prime I'.
Cut size after Perm. Patch
No.Cuts
Final Billing $
Amt. Due Payee $
Amt. Due Town$
Applicant is responsible for contacting
the Police Dept.and C.B.Y.D. 97 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:_ `T—.c�C,�..�� 5
/ Date:_ 22 .
Title: y .fie S` D.L.#_ CO 2og
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES