HomeMy WebLinkAboutNew Sanitary Lat Street Cut Permits Inte i
Permit No.
Date 4127
11/17/2005
Town of South Windsor
Expiration Date 11/17
Descri /2006 Street Excava CT
p EXCAVATE tlon Permit
TO INSTALL SANITARY FOR�� LINE
Applicant,.'
Name SIMSCROFT ECHO F
Addr.
P
BOX Lnaton
P.O. 581
SIMSBURY CT 2NT$IZSECITp W✓$UCKLANb
Phone (860 06074 ROAD
)651-0231
���� o� i�ork 'i�TE#T BAD LAB
re Applicant agrees t
quired an oUrriih
Incurred b d to
r�lmkrurse t the xoWh South
and Torun mare-T Csf Sod V. ,ndor Farr the amount of bond
Y the for 4tvnn'daOpermit thatHance °
regulations applicant isepir an'.�xpenses
Cut Permit Manuapermats "as cauI1nd � w .C � w� T. badennection with this
tb : Town 1y;the rules
SA.ut} tindr and
so
s Street
PERMIT Tp
BE.K$PT
Issued by ON }Qg STTE AT:
nA
ALb.'TES.
Date `-------
Completed ---- T1`tle
-------------- --� -- ------ —
--- Inspected By
L
TOWN OF SOUTH WINDSOR INSPECTION
Permit No.
4127 REPORT
Location INTERSECTION W/BUCKLAND I
Type Work NEW SAN ` CortCractor BiMSCROT LAT ROAD..- Address P Q ECHO FARMS
BOX 581
Pho �sS`1'MS}�U,RY �T '06070
e N�, BSJ S1 023�Date Insp Needed s
Time Insp Needed -------- —
Inspected By -7 Tlme T?1
dk. ass p,
ork in Progress
--- = Al- Sw
77
-------------
- s
.t
APPLICATION FOR STREET EXCAVATION PERMIT 4rz--)
TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR,CT 06074
FEE $25.00
Name of Firm ` Phone No.
Address of Firm
Location of proposed-ork
Describe fully nature of permit requested Lg2r& � ^
Starting date _ A Approx.time for completion
Call Before You Dig No. - t / Traffic Services Control No.
Show sketch of proposed work or furnish Indicate North This section to be filled out by
two copies of separate drawing Town of South Windsor
Pavement Cut I
No.cuts
Est.Size of Perm.Patch(s)
Est.Pvt.Thickness in.
Est.Unit Price$ 10 y�o
o�
Amt.of Deposit$
Total Due$ by
Cash( )Check#
-- Permanent Patch
No. Cuts
Size of Patch(s)
Final Billing
S�Tc�W
Amt.Due Payee
v
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:
Title: Driver's License#:
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
/
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