HomeMy WebLinkAboutGrade pave Street Cut Permits 25 Country APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS-DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSORf CT
FEE $25.00
Name of Firm % C Address of Firm Phone No. L
Location of proposed work '`�.�; �e r�r� t-1, V t cam.
Describe fully nature of permit requested
Starting date_ Approx.time for completion O • c
Call Before You Dig No. Traffic Services Control No.
Show sketch of proposed work or furnish
two espies of separate drawing To be filled Wi
out by Town of South ndsor
Pavement Cut
Indicate North Prop.size of cut
No.cats
Amt.of Deposit$ by
()Cash()Check#
Cut size after Perm. Patch
No. Cuts
S� w Final Billing$
Amt. Due Payee$
Amt.Due Town$
Applicant is responsible for co tatting 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 JAM 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: Q
PERMIT SHALL BE KEPT ON 70BSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc