HomeMy WebLinkAboutWater Street Cut Permits 25 Brookhaven L Permit No. 3378 Town of South Windsor,
-gate 08/22J2002 CT
Street Excavation Permit
- Expiration Date 08/22/2003
Descrip: VALVE TO BE REPLACED IN C - OF CUL DE SAC
Applicant AN, N Location
Name MDC Addr. P.O. BOX 800 KHAVEN LANE
HARTFORD CT 061 2 o k WATER
Phone (860 )278-7850
Applicant agree h fTw ndsor the amount.,pf bond
required and to re ' a ou for any expenses
incurred by the To int re 40q in connection with this
permit and that ap A'P h y_T1 abide by the rules and
regulations for pe a Cut Permit Manual . o South Windsor's Street
� ! �, ,
* * �
PER T i T ALL TIMES.
Issued by S le
Date Completed Inspected By
TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 3a Contractor MDC
Location ht "" - Address P.O. BOX 800
Type Work WATER HARTFORD CT 06142
ne No. (860)278-7850
Date I nsp Needed �6?
Time I nsp Needed As-,7),
S
Inspected By
Work in Progress ✓ a
C;o �k
01' It. 31
t3
� f
t --ILU" " Date
„Aug-22-02 07 : 24A P.01
MDG
The Metropolitan .District
FAX
To: C �� From:
Fax- Pages:
Phone: Date: -- 2 .-
SUBJECT:
125 Maxim Road Hartfordy Connecticut 06114
Fax: 860-550.7961
Telephone: 860�278.7850 Systems Repair ext. 3610
Construction - Survey ext. 3631
„Aug,,22-02 07: 2.4A 3 37e R.02
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm_ Phone No, c- Z(� ^ / ,�f ,'�5 � _j�l <
Address of Firm 1
,Location of proposed work �/
,k Describe fully nature of per it requested
Approx, time for completion � y2✓'
)(Call befcxe you dig no,� _� � Z�r Traffic Services Control No.
.dhow sketch of proposed work or furnish To be filled out by Town of SO. WhIdSor
two copies of separate drawing Paveme ant Cut
Indicate North
Prop. size of out
/ dd
� c//r C'1.1 Na. cuts
-Jr. _
Amt_of Deposit i by
(I Cash( I Check#
Cut SIZe after Perm_ Patch
No_Cut$
Final BWlinq 5 �
Amt. Due Payee $
Amt. Due Town 6
Applicant is responsible for contacting LL
the Police Dept. and C,9.Y.D. by date
I AGREE TO FURNISH TO THE TOWN OF SOUTH WINDSOR THE AMOUNT OF BOND REQUIRED AND TO R�IMSURSE 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 Al,8IDE 13Y THE RULES AND AEGULATIONS FOR PERMITS AS OUTLINED IN THE
TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: ` //� Date: d
Title- ��-�' �-�
PERMIT SHALL 6E KEPT ON JOBSITE AT ALL TIMES
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