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HomeMy WebLinkAboutSanitary Sewer Street Cut Permits 3 Cha Peen, t'No.' Date 2353 09/23/1997 Town of South Windsor, CT Street Excavation Permit Expiration Date 09/23j' 19q$ Descrip: CK3962 IS FOR PATCH FEE & Ck2398 IS FOR PERM IT FEE Applicant Name SIMSCROFT ECHO FARMS location Addr. P.O. BOX 581 3 CHANDLER ''1JRIVE SIMSBURY CT 06070 Phone (860)651-0231 Type Of Work N,EW SAN LAT Applicant agrees to fu rn l sh the Town © 'South W.�n required and to re i mburs the' ,Towni of 'Sairth ,thsor 'for an expenses incurred by the Town for-- m61-ntenaAc nh � pair dsor the amount of bond Permit and that applicant s yconnection wQr in connection with this regulations for ami yar �flthh and _fl I', abide by the rules and permits outlined .ire the Cut Permit Manual , ToW `of South Windsor's Stree t * i PERMIT TO'.BJw KEPT 'ON ,AT ALL TIMES, Issued by Date Completed �--�.-- Titl;.e _.. -"��--- — Inspected By APPLICATION FOR STREET EXCAVATION PERMIT TOWN OF SOUTH WINDSOR PUBLICWORKS DEPARTMENT TOWN HALL 1540 SULLIVAN AVENUE SOUTH WINDSOR, CT FEE $25.00 Name of Firm C CA- (VAO•*•S J C Phone No. pto 0 (o Address of Firm V1.0 • •'ram vv ef• O 7 0 Location of proposed work LO i _ f filJj�LF 2lJF' Describe fully nature of permit requested Starting date Approx.time for completion Call before you dig no. Traffic Services Control No. Show sketch of proposed work or furnish To be filled out by Town of So. Windsor two copies of separate drawing Pavement Cut Indicate North Prop.size of cut fJ— No.cuts_ 4 Amt.of Deposit$ *�t� by ()Cash A Check# �9U z � Z`?,98 ( L Cut size after Perm. Patch No.Cuts Final Billing $ Amt. Due Payee $ Amt.Due Town$ Applicant is responsible for contacting the Police Dept. and C.S.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: �Ct,v�t1/ C_ - [ Date:— Title:- // - D.L.# O 0 1010 s y p PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES