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HomeMy WebLinkAboutNew Sanitary Lat Street Cut Permits 349 Permit No. 225�3 C'�te 11,/t7i/y596 Town of south Windsor,Expiration Dade t1/`«1I1g � Street Excavation Per•mitT Descrip: SANITARY LATERAL, Name JUHN LAWRENCE IA i"ES Addr.. 486 PROSpeCl AVENUE: HARTP©f�f� CT i1�i Phone 1�» ,g Cf A#�h; ST iEk.7 ( � ._ . ,Type of Wor ��� Lf�iY SAN L AI Applicant agrees tj futnishthe7ow r`epu i red and to reimb(jrse of ,South W�t�dsor the am��unt incurred by tf7e Town for the %down of 'South Windsor" for any mairtenar�ce or of bond per, i t and that app°i s cant i s f arm °i'�tr withpnd worf� i rt expenses regulations for perm i r:s as taut 1 a nevi n connection with Cut Permit W7 � t ab7de by the rules this Martian thQ Town of South Windsor ' s and Street Tss ij PERMITA�,TO CAE KEPT ON/ 'JOB SIZE AT ALL TIMES . ued keyf Date Cmp Tit.1 e .et d _ _. - .�,, Inspected by '`,� r APPLICATION FOR STREET EXCAVATION PERMIT TOWN OF SOUTH WINDSOR PUBLIC TOWN DEPARTMENT 1540 SULLIVAN AVENUE SOUTH WINDSOR, CT FEE $25.00 Name of Firm—li - I _ / FE c C' S Phone No. 17 J "- 47] 4, Address of Firm , ♦ ' — C)fl�0 ' Location of proposed work 34 L Q.LA f? — 7 Describe fully nature of permit requested L x C A U /''1'1 C / 7 %Q P /k'.�-/' A(-L A L/C 0 C) J- Starting date l Approx.time for completion b 0 C7G Call before you dig no. Traffic Services Control No. Show sketch of proposed work or furnish To be filled out by Town of So Windsor two copies of separate drawing Pavement Cut / //� Indicate North Prop.size of cut 1� / C 1Z 46) No.cuts_ nL Amt.of Deposit$ i /(1 Cash( Check Cut size after Perm. Patch No.Cuts Final Bill' �' Amt. Due Payee $ Amt.Due Town$ Applicant is responsible for contacting the Police Dept.and C.B.Y.D. by date I AGREE TO FUPAYISI i TOT T N OF SOUTH WINDSOR THE AMOUNT OF BOND REQUIRED AND TO REIMBURSE THE TOWN OF SOUTH WI DS F RAN EXPEN ES INCURRED BY THE TOWN FOR MAINTENANCE OR REPAIR WORK IN CONNECTION WITH THIS PERMIT A D T A AM F MILIAR 7PERMIT ABIDE BY THE RULES AND REGULATIONS FOR PERMITS AS OUTLINED IN THE TOWN OF OU H DSO 'S STR MANUAL. Signed: . Date: jq6 Title: D.L.B PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES