HomeMy WebLinkAboutRepair CB Street Cut Permits 178 Chapel Permit No. 2357
Date , qg/25/ yg97
Town o�" South Windsor,
Expiration Date of Street Excavation Permits
2
Descr i 0�, 51 y 9�S
P: REPAIR 2 STORM DRAINS
Applicant
Name COVEN CONSTRUCTION Location
Addr . v RUCT?GN CO,
P•G. BOX 427 017. CHAPEL', ROAD
COVENTRY CT 06236
Phone ( 860)22-0526Ype of Worm 'STORM
Appiieant agrees to f
urnish the town of Sautl� ���dsar
required and to reimburse
incurred by the Town for the` Tow h d� ��?uth W� the amount of bond
Permit and that a is n`tenance car +1dsa�r ` for any expenses
p�alican n' Pair wa'rk in connection with this
regulatioe�s tor �s` far Ili s with and
permits a1 autlined in wl, abide by the rules and
Cut Perms t Manual . ti�te+ Town cxf �,
.youth Windsor' s Street
PERMIT' To BE k,EPT +N -J.C?$ .SZ.T AT ALL
Issued by TIMES.
Date Comp i sled T i,t 1'e
.-
Inspected By .�'
Z 3S�
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 CALIIS4
Phone No. I c� �J j
Address of Firm U vC. UL!5-A-J'V-1
Location of proposed work rT r. ( f) �
,u-
Describe fully nature of permit requested
A-. U OCU
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
No.cuts A/
Amt.of Deposit $ by
O Cash O Check#
Cut size after Perm. Patch
�. No.Cuts
Final Billing S
Amt. Due Payee $
Amt. Due Town $
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 WINDSO 'S STREET CUT PERMIT MANUAL.
C'
Signed: / Date:t G Ed (� �f )
Title: f!/% D.L.# d D"b G
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES