HomeMy WebLinkAboutSanitary Sewer Street Cut Permits Avery (3) {
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
Amt. Bond Required_;�� PUBLIC WORKS DEPARTMENT
Amt. on File , , TOWN HALL
Date of Expiration Permit 23
1540 SULLIVAN AVENUE $�Ins. on File ( es t No SOUTH WINDSOR CT Date
Expiration Date FEE $25.00 ' Permit Expires
Name of Firm $�i m .f C t"q r T C+�G yes, f .y.�
Address of Firm • /�d sll ly . r a G
Location of proposed work fXvF wy S� ..�G�2 L Phone No.
444C9 ps
Describe fully nature of permit requested—
Starting date S! :� L~ 7 f
Call before you dig No. At<' -*616ey f$_T— Approx. time for completion
Traffic Services Control No.
Show sketch of proposed work or furnish To be Titled out
two copies of separate drawing bV Town of South Windsor
OIndicate North Pave_ me"-__t Cut
��tL
Prop. size of cut i� 7W 5(v�+ii 1ws/0/,l
No. cuts
Amt. of Deposit $_ by
W�
Cash O Check #—
Cut size after Perm Patch
No. Cuts
Final Billing $
Amt. Due Payee $
Applicant is responsible for contacting Amt. Due Town $
the Police Dept. and C.B.Y.D,
by date
I agree to funish 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 J" Title:
D.L.L.# Date: Z / ✓ t
PERMR BE ON AT ALL TIMES
APPROVED: , DATE:_
TO NGINEER
FOR INSPECTOR: Date work started
Pate Completed
Signed Date
WHITE PERMIT
YELLOW ENGINEERING PINK --ST. SERVICES
GOLDENROD FINANCE