HomeMy WebLinkAboutStorm Street Cut Permits Avery Street at Permit No. 2877 Town of South Windsor, CT
Date 10/04/1999 Street Excavation Permit
Expiration Date 10/03/2000
Descrip: MISC. SMALL DRAINAGE PROJECT
Applicant Location
Name GERBER CONSTRUCTION CO PORTN OF EVAN'S CROSSING
Addr. 616 DART HILL ROAD
VERNON CT 06066 Typro,",�of Work STORM
Phone (860 )875-6684
Applicant agrees to furn i .the ;,TOWn of S ,uth, Windsor the amount of bond
required and to reimbuu so .the,. T�own, ,, for any expenses
incurred by the Town for rna�r n uance Or'; repdt r'"wor in connection with this
permit and that app 1 rcaat ' fami 1�. r Wi" h and :wti 1 1abide by the rules and
regulations for perm"It �, dL lin din" a Town Hof South Windsor's Street
Cut Permit Manual .
* * PERMIT TO: BE"
E KEPT bg ,J08 .SITE AT ALL 'TIMES.
Issued b , J2
Date Completed f : Inspected By
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm C.
Address of Firm m�. Phone No.
Location of proposed wo ✓ Q,. �/
!'rsYi h
Describe fully nature of permit requested r 1•,_ ,
Starting date !J Approx.time for completion
Call Before You Dig No. , Traffic Services Control No.
Show sketch of proposed work orfumish - To be;filled.out by T wn of-South Windsor.
two.copies of separate drawing" -
Pavement Cut
Indicate North Prop.side of cut
No.cues
n I f D
Amt.of � b
y
O Cash t;)Check#
Cut size after Perm.Patch
No. Cuts
Final Billing$
Amt.Due Payee$
Amt. Due Town$
Applicant is responsible for contacting by the P Ace Dept.and CX.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:- /�'� D.L.#• �� �-��/f�----
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc
tOWN OF SOUTH WINDSOR INSPECTION REPORT
PROJECT: DEVELOPER:
AJ S"C pQRwAGti, �M(t
STREET A)cg-T t OF f-yAIS CONTRACTOR:
DATE:
AEG. 1; 1-t)-,) 71ME: f?` 4-5'
WEATHER c -c oy INSP: -s FECAJA
WORK IN PROGRESS:
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AREA OF CONCERN:
SPECIAL INSTRUCTIONS: