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HomeMy WebLinkAboutStorm Drainage Street Cut Permits 349 Cl �a Permit N.O. 2271 p C:ite 01/15/ 1997 - Town of South Windsor, CT Street Excavation Permit Expiration Gate G115i199S Descrip: COLLECTOR EITORM .uRATN 8 Pvt; Y Applicant Loc;at ;on Name JOHN LAWRENCE ASSOCIATES ?49 Addr , 466 PROSPECT AVENUE HARTFORD CT 06105 Phone ( } - Type of W6'-k. STORM Applicant agrees to fu rn i 5h the Town of S©uth, 1�t,7 neisor required and to reimburse he, Taw .o the amount of bond incurred by the Town for m$t�itenance � � �iaW�ntl�sor fOr any expenses Permit and that app; icant isarhla�r w:,rep orki connection with this regulations ror permits .. nd. i'I1. abide by the rules and Cut Permit Manual . as 1�. � Town of South Windsor ' s Street PERMIT TO BE"''(tEPT "4N :JUBrT . AT ALL TAMES . :issued by Date Completed Inspected By r APPLICATION FOR STREET EXCAVATION PERMIT TOWN OF SOUTH WINDSOR PUBLIC WORKS DEPARTMENT TOWN HALL 1540 SULLIVAN AVENUE SOUTH WINDSOR, CT FEE $25.00 Name of Firm Q LEW Q _0 CIE- Phone No. 2�.;2- 4-7 4® ,(Zu -025--0 JAc Address of Firm S C AQ `�✓✓✓ Location of proposed work 7 4 6t ('L A f?V `'- Describe fully nature of permit requested E M (fU E As cleF?CAAJ Starting date Approx.time for completion -J DA cue Call before you dig no. Traffic Services Control No. Show sketch of proposed work or furnish To be filled out by Town Of So Windsor two copies of separate drawing Pavement Cut Indicate North '1 Prop.size of cut h No.cuts Amt.of Deposit$ by D l � , ()Cash()Check G #f �s3s I p , �CQ S ✓ Cut size after Perm. Patch No.Cuts l Final Billing$ Lj N Amt. Due Payee $ ( I p V Amt. Due Town$ Applicant is responsible for contacting the Police Dept. and C .D. by date I AGREE TO FU SH THE TOWN OF OUTH WINDSOR THE AMOUNT OF BOND REQUIRED AND TO REIMBURSE THE TOWN OF SOUTH tND S OR NY EXPENSES IN URRED BY THE TOWN FOR MAINTENANCE OR REPAIR WORK IN CONNECTION WITH THIS PERMITT T 1 AM .AMILIAR WIT AND WILL ABIDE BY THE RULES AND REGULATIONS FOR PERMITS AS OUTLINED IN THE TOWN 0U NDS 'S STREET UT PERMIT MANUAL. Signed: Date: ' 1 Title: D.L.# / 7� PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES