HomeMy WebLinkAboutCATch Basins Street Cut Permits Ayers R Permit No. 3789 Town of South Windsor, CT
Date 07/08/2004
Street Excavation Permit
Expiration Date 07/08/2005 Y`y '
Descrip: 2 NEW CATCH BASIN'S-FOR 'POW�N>' I `5�.>>' E ,j +::<•.:.,,y
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Name GERBER CONSTRUCT> "„
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MEG DRIVE
LLINGTON CT 06�D$ 2>9fti:
Phone (860)875-6684 ..
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required and to rei' bizVBe->:'tat '
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incurred by the Towri:: > ; y riiataanc>e or repairer <: :nt': t =action with this
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permit and that applicant I " aril i: .xt � ;W� 17�i+ e ,tay tk e rules and
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regulations for permits a_q':o'u:C'Idne'= '-'_-> Tp:'tg ''o;f S, ttith.Vl::jrt'd. or's Street,z a et
Cut Permit Manual.
* * PEE'RMIT TO B�'K�P�' .ON SOB ' ITN �T J�73L'i TIMES
Issued by
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Date Completed ...—........ Inspected By
TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. / 3789 r+i Conti-aCtor> GERBE`it-CON.STRUCTION CO
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Type Work MISCELLAN 3.•31 N_GTN.;:> :. ,06`0: 9
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r+rruL.H I lvly t-UK STREET EXCAVATION PERMIT -� -7,j"
TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT 06074
J FEE $25.00 -
Name of Firm �` . ��� (�
Phone No
Address of Firm
�' Z •
Location of proposed work / k— Co pl G
Describe fully nature of permit requested Z �. Gl� r,5, )< a
Starting date 6 v
Approx.time for completion
Call Before You Dig No. Traffic Services Control No.
Show sketch of proposed work or furnish
two copies of separate drawing Indicate North This section to be filled out by
Town of South Windsor
Pavement Cut
No:cuts
N
(� C L�Y; Est.-Size of Perm.PatdKs)
Est.Pvt.Thickness
Est.Unit Price$
Amt.of Deposit$
Total Due$ by
^� ( )Cash( )Check#
11 ,
b
-Permanent Patch .
No. Cuts
Size of Patch(s)
Final Billing .
$
Amt.Due Payee
i
Amt.Due Town
By
Applicant is responsible for contacting the Police Dept.and C.B.Y. DateD.
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: l� �_-_ U
Title:_ e
Driver's License#: 'IT Z-
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES