HomeMy WebLinkAboutStorm sewer work Street Cut Permits Aver Permit No. 2876 Town of South Windsor, CT
Dates 10/04/1999 Street Excavation Permit
Expiration Date 10/03/2000
Descrip: MISC. SMALL DRAINAGE PROJECT
Applicant , Location
Naive GERBER CONSTRUCTION CO, ` IUTERSt"CTION 0 BEELZEBUB RD
Addr. 616 DART HILL ROAD
VERNON CT 06066 T Ype"of Wor`k STORM
Phone (860 )875-6684 �
Applicant agrees tQ --furAi:sh_Etho, Town of South, Windsor the amount of bond
required and to re i mb�Ur,se, t;hr�e ,:T w t" o South W'a rid or, for any expenses
incurred by the Town for m �ntenance o^ repair` work-,.in connection with this
permit and that appl -rcant ils-`; famlicih and,�t,i7l abide by the rules and
regulations for permfts: s tl i re � n e Torn �'6,f 'South Windsor's Street
Cut Permit Manual .
* * PEERMIT TO BE: KEPT Alt Joe SITE; AT ALL TIMES.
Issued by '� yNA T 7 t l e �5�c.-fsflL
gate Completed Ins scted BY�, ��
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APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH-WINDSOR
PUBLIC WORKS DEPARTMENT—
TOWN HALL
-- 1540 SULLIVAN AVENUE
SOUTH WINDSOR CT
l r— FEE $25.00
Name of Firm ��✓tbn ..
Phone No. 5��
Address of.Fi
tPI
Location of proposed work_ , se !✓
Describe fully nature of permit requ r e. A,tr
Starting date 57 -9 Approx time for corn tton�0�Call Before You Dig No. Traffic Services Control No
Show sketch of proposed work or furnish
two copies of separate drawing To be filled out by Town of SouM Wind or
' Pave—_-m�"t.C��
Indicate North Al
Prop.size of cut i
No.cuts
l �l Amt.of Deposit$ by
of
- O Cash{)Check#
Cut size after Perm. Patch
No. cuts
Final Billing$
Amt. Due Payee$
Amt. Due Town$
Applicant is responsible for contacting by
the P Ace De t. 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:_./
Title:
PERMIT SHALL BE KEPT ON 70BSITE Aj ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PROJECT: AV DEVELOPER
STREET. CONTRACTOR: ���
DATE.
c, 'Nen9 TIME: 9 a
WEATHER: INSP: J Q �
WORK IN PROGRESS.
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AREA OF CONCERN:
SPECIAL INSTRUCTIONS: