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HomeMy WebLinkAboutWater Street Cut Permits 141 Beelzebub R Hermit Wo. 2241 -A Date, 09/15/1996 Town of South Windsor Street Excavation Permit Expiration Date 09/ 19/1997 Desdrip: WATER SERVICE CONNECTION Applicant Name STATE LINE SEWER & CON,STO Location Addr. 238 SHAKER ROAD i`�1 BEELZEBUB ROAD ENFIELD Phone (860)749�6y �6082 6 .' Ypo 0 Worm ,WATER Applicant agrees to furn i sh thel towri`� required and to reimburse th+a .TQwn . f f §66-th, W1nd$Or the amount of bond incurred by the Town f©r "the Town, orQrehav1ndsor for an permit and that appiicnt i Y expenses p wprk ..i n` connection with this regulations for s'.fami liar ��tt� and r�r,iilabide b permits as ,PutI ned in the ,Town ,af Y the rules and Cut Permit Manual . South Windsor's Street *tjPERMIT T© BE .KSPT ©N JOB,' SITE ATALL TIMES. Issued by Date Comp i eltedl J Inspected By APPLICATION FOR STREET EXCAVATION PERMIT az yi TOWN OF SOUTH WINDSOR PUBLIC WORKS DEPARTMENT TOWN HALL 1540 SULLIVAN AVENUE SOUTH WINDSOR, CT FEE 25.00 Name of Firm S , 7` Phone No. Address of Firm Si Location of proposed work Describe fully nature of permit requested i is Q ae ere 2r C, f.c. Starting date Approx.time for completion , Call before you dig no. �! C 3 8 o O o �/ Traffic Services Control No. Show sketch of proposed work or furnish A I To be filled out y Town two copies of separate drawing /V of Windsor Pavement t CAM Indicate North A /� �� Prop.size of cut � }� F!� a 0.4T"AA No.cuts—L— � rs/�a 54�e %l�.a�yt / Amt.of Deposit$z�by lL v cr�i r 7 ()Cash()Check# Cut size after Perm. Patch No.Cuts Ne"l &0,05° Feral Billing15 $ Amt.Due Payee $ $ Applicant is responsible for contacting Amt.Due Town 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: sz - D.L. o PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES � Z13 Z .3 zIF