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HomeMy WebLinkAboutWater Street Cut Permits 81 Beelzebub Ro Permit No Date 2389 997 lcwn Of 3outr i + � ;ndsor, :T Ex + rat Street Excavatiot) Permit Oesc,r l p ion Date 1 1/24; ; ggg App 1 i cant Name STATE LINE l-Ocation Addr. �E4NE�4 & Cf7 ;aT Ct� 1 13 EL 'tB ROAD238',,SHAh:E'P ROAD ENFIELD CT 06082 Phone (860)749-61 76 Tvpe of WATER Applicant agrees r, required and to rep mburse heTOwn Qf Owif8o+at 4 �hdsbr the amount Of bon "incurred by the TOWn •F c�uth Wi ,dig .'far �Permit and that a or main,tenand, Or to air any expenses pp l i cant. ;�s ,fami l 1 p, Work i n connection with tF�Y s regulations e9u l at i ons or perrni is as ' 0 W'ith Ond�:w 1,1 1 'abide by the r Cut Permit Manual . ut ' 'i►�eq an the ©Wt _:of 5�utti Windsor 's erules and Street 4* * PERMIT TO 8E KEPT JiB SITE Issued b ,� AT ALL TIMES. y o- � Date cornplete Inspected By • APPLICATION FOR STREET EXCAVATION PERMIT -2 TOWN OF SOUTH WINDSOR ' - PUBLIC__ ORKS DEPAENT OWN HALL-----'----- 1540 SULLIVAN AVENUE SOUTH WINDSOR" I DSOR, CT FEE $25.00 Name of Firm U Phone No. $160-'7 cy—to (I t0 Address of Firm Q Location of proposed work r Describe fully nature of permit requested Starting date Approx.time for completion Call before you dig no. Traffic Services Control No. Show sketch of proposed work or furnish TO be filled out b TX own Of SO. Windsor two copies of separate drawing Pavement Cut Indicate North Prop.size of cut ,r�-U t 1,96 j No.cuts_ Amt.of Deposit Ok 7-0 byl�ow O Cash Check 0-1114nf 1 / . l Cut sue after Perm. Patch — — � No.Cuts n Final Billing S Amt.Due Payee 3 Amt.Due Town S Applicant is responsible for contacting the Police Dept.and C.S.Y.D. by 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.# PERMIT SHALL BE KEPT ON JOSSITE AT ALL TIMES