HomeMy WebLinkAboutMiscellaneous Street Cut Permits 60 Bidw Permit No. 3674 Town of South Windsor, CT
1 Date 04/15/2004 «f.:.. Street Excavation Permit
Expiration Date 04/15/2005 '
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Applicant
Name COSTA & SON, LLC <` Eli'TS.....:......:
Ad dr. P.O. BOX 658
SOUTH WINDSOR CT Q�FT7A,:z":;:>`°•>::': `.= `�e� , �,,,:.,: : � �'; .; :: .
Phone 860 644-2499 :
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permit and that a 1 .dad:t. s .€.a .:: ;: ,.. +t :< t?3vzk? '> k: a <'by > 'he rules and
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regulations for permAs as 'ou't`3 `i. .d;. '% Yi .: a.,.
Cut Permit Manual.
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Date Completed Inspected By
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Permit No. 3674 Contx40:t`" C..'.9I A"1-&r«:SON, LLC
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APPLICATION FOR STREET EXCAVATION PERMIT 3�4-
TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT 06074
pp FEE $25.00
Name of Firm G G4 'go n /-L C- Phone No. 0 a-
Address of Fir D x (o Sk S,
Location of proposed work
Describe fully nature of permit requested yh�ST/�II Nam► (�n�c. Ip�.w�ac,�CS
Starting date_ AML -1 Approx. time for completion 2 '�)Agy
Call Before You Dig No. Traffic Services Control No.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
Pavement Cut
2 )
J r� r>)pVjlvt I`�Q� QCA/J No.cuts
/ Est.Size of Perm. Patch(s)
2�� b Est. Pvt.Thickness in.
I Est. Unit Price$
Amt.of Deposit$
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.
Signed: Date: 'y Z- 'o,
/
Title: r, -ei Driver's License#: 1 a k 7 3-
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES