HomeMy WebLinkAboutWater Street Cut Permits 9 Birch Hill Dr s --
Permit No. 2504 Town of South Windsor, CT
Date 10/16/1998 Street Excavation Permit
Expiration Hate 10/16/1999
Descrip: REPAIR BROKEN WATER MAIN
Applicant '
Location
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Name CONNECTICUT WATER COl�PMY
SOS E RCA S ILL DRIVE
Add r. 25 NORTH ROAD
EAST WINDSOR CT 06088 e WOrk WATER
Phone (860)292-5552
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Applicant agrees to f'u rash the Trt cif SdLtthp i ndsor the amount of bond
required and to reimborse �, e,,.Town off' , rh WpQrr any expenses
incurred by the Town fort` rp ai Yvt air d 'k connection with this
pe rmi t and that app l i cant. amt�. i �1d ;l T; 3 i de by the rules and
regulations for permits ,, s rru a tt�� °. ; �. e= I" riff-`"S�o'uth Windsor 's Street
Cut Permit Manual .
* PERMIT TO BE' KEPT ON JE3B S.IT� AT, 'ALL TIMES.
Issued by A
Date Completed Inspected By
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm ! i�l�'—� \ Phone No. 12(1 11
Address of Firm `> rl
Location of proposed work
Describe fully nature of permit requested ' 9 9 ) ,
Starting date Approx.time for completion
Call before you dig no. C0 Q Traffic Services Control No.
Show sketch of proposed work or furnish j To be filled out by Town of So Windsor
two copies of separate drawing ( Pavement Cut
Indicate North { Prop.size of cut
No.cuts
Amt.of Deposit $ by
O Cash O Check#
� Cut size after Perm. Patch
No.Cuts
Final Billing $
Amt. Due Payee $
Amt.Due Town S
Applicant is responsible for contacting
the Police Dept. and C.B.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: �a _ ��d L _ Date:
Title:_0qQJ A YK D.L.#
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES