HomeMy WebLinkAboutElectric Street Cut Permits Buckland Roa Permit No.
Date 2583
06/20/200o Town of South Windsor, OT
ExGi ?" Street Excavation Permit
anon Date 06/,�O j2001
Descrip : REPLACE- SOLES iN PLACE
Div
App 1 i Cant. G:F$'11x f
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Name CL&P LoatioT�
Addr. 48 TOLLAND ST,=GC RD B Ck LANiJ RC•
AT MANCH TOWN LINE
TOLLAND CT 06084
Phone (860)871 -3443 Type of Work, ELECTRIC
Applicant agrees to furnish the Town of Sau
required and to reimburse. the. Town of South Windsor for an
th Windsor the amount of bond
incurred by the Town for maintenance° or repair work in
Permit and that a Y expenses
i�plicant is familiar ,with and will abide nbyc the nrules and with
regulations for permits as outilned in
Cut Permit Manual . :the ' Town Of South Windsor 's Street
(V * PERMIT_T' .%)BE: KEPT
4M
1 JOB SITE AT gI�TIMES. a�Issued by Ti` _ r ._ //
Title l �
Date v om - ',
pietafs
Inspected
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APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOk CT
FEE $25.00.
Name of Firm (/L T Phone No.
Address of Firm 7o il/p To
Location of proposed work
Describe fully nature of permit requested 2
D F TF/6//1 �Sf(S i i //r L pz�^s
Starting date ( Approx.time for completion Z
Cali Before You Dig No. Z Traffic Services Control No. 'T`
Show sketch R proposed work or furnish TiD be filled allt bX Town of uth Vjndsor
two copies of separate drawing
Pavement Cut
Indicate North Prop.size of cut
No,cuts
A *2805Z Amt.of Deposit$ by
,t 28�51 ()Cash()Check#
® �✓iWOO Cut size after Perm. Patch
` No. Cuts
Final Billing$.
Amt.Due Payee$
Amt.Due Town$
Applicant Is responsible for contacting by 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.
/ rp Signed: Date: lO 112 VI v Gc�Title: D.L.#•
PERMIT SHALL BE KEPT ON]OBSITE AT ALL TIMES
Standard FormsNParm1ts\$VM i=vation Permitdoc