HomeMy WebLinkAboutElectric Street Cut Permits 450 Clark St (2) APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR \.
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm \AWD C0rv57Ryc.Ti wA Co. } rvQ . Phone No. -7G3_Li i F35
Address of Firm zz3 woop Zoaq, Sor- c-" c 0(-0-7 t- ►z-\Zl
Location of proposed work1Z�a��
Describe fully nature of permit requested N-w
Starting date Pa. %z Approx.time for completion z ID",-)
Call Before You Dig No. Traffic Services Control No. iv A
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
#- y-7 q Pavement Cut
Indicate North Prop. size of cut 2�.X
No. cuts I
Amt. of Deposit$ {;31 - 7_6 by
Cash Check# 954-
Cut size after Perm. Patch
No. Cuts
Final Billing $
— --S Amt. Due Payee$
Amt. Due Town$
Applicant is responsible for contacting 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 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: L WADate:
Title: I Ro Ec -, Mc sz
D.L.#: '?(;z:767--7 1
PERMIT SHALL BE KEPT ON 3OBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc