HomeMy WebLinkAboutStorm sewers Street Cut Permits 9 Bancro Permit No.
• 3681
Date 04/21/2004
Town of South Windsor, CT
Expiration Date 04/21/2005 Street Excavation Permit
Descrip:
Applicant
Loca< ion
Name
BEDNAZ EXCAVATING.; T`N'E� r.aa f
Addr. 139 WEST GRANBYOAp $ NCROET
?NE x
GRANBY CT 06035 ✓
Phone (860)653-2563 T
a A Wors3TbR
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Applicant agrees to 'fur k y
ath G$e :Ts�vu required incurred by
to rezmbur'.se th. own 'of g9tfh Wirygnr tie count of bond
r
P Y the Town fcr# a�nLenanch3sorpn. expehses
ermit and that apprcahmx ?9rk i ctVn#2eoidn with
regulations for pernTlts`
# it a this
s. a tl >ts: .1. b�de by the rules and
Cut Permit Manual. fined in jhe Town oft„ ..: sa'
s Street
* * PERMIT`;TO EE
ICERT L#1� �7$ xSTT� �'� ALI, fiIKTE,S <* ^*
Issued by � P:
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` TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 3681
Location 0009 BANCROFT LANE Contrg..Q.b<ty "ffE17 Z%,-EXCAVATING, INC
Ac 'res:s:>x €'a739 f:ES .,,..G12§tiB Type Work STORM Y ROAD
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Time Insp Need
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Inspected B
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Work in Progress
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APPLICATION FOR STREET EXCAVATION PERMIT 3(151
r TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT 06074
FEE $25.00
Name of Firm ��,�� y Z V C w41., C Phone No. , l�>- G.S_5- .
Address of Firm
Location of proposed work
Describe fully nature of permit requested
Starting date
Approx. time for completion 4 yj,
Call Before You Dig No. Traffic Services Control No.
Show sketch of proposed work or fumish This section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
Pavement Cut
f No.cuts
0Est.Size of Perm. Patch(s)
Est. Pvt.Thickness in.
Est.Unit Price$
� l Amt.of Deposit$
\ tea_
y (d Total Due$ by
Cash( )Check#
Permanent Patch
No. Cuts
Size of Patch(s)
Final Billing
Amt. Due Payee
Amt. Due Town
By
Applicant is responsible for contacting Date
the Police Dept.and C.B.Y.D.
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.
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Signed:
v / Date:_
Title: /r f
�� Driver's License#:
PE MI SHALL BE KEPT ON JOBSITE AT ALL TIMES