HomeMy WebLinkAboutDriveway Street Cut Permits 121 Connecti Permi No. 3099 G6 �6 Town of South Windsor , CT
Gate 04/30/2001 G: Street Excavation Permit
Expiration Date 04/30/2002
Descrip:
Applicant Location
Name DMK CONSTRUCTION ING AVE
Addr. 258SANDY BEACH RD
ELLINGTON CT 06029 Trc� oN y+ rk ,DRIVEWAY
Phone (860)871 -2149
�r
Applicant agrees to .fur�n tseh the Town oftiwk- :Wl ndsor the amount of Mond
required and to re i mk urse �Ye fio t 2 0' ,; $0uU h �f 1�dsor far any expenses
incurred by the Town for r'tr ena e or epair Wctih in connection with this
permit and that applict T rfa �r"'°Wr anti" zi1 abide by the rules and
regulations for permits " � ►` 1odt1; af, South Windsor' s Street
Cut Permit Manual .
* * RMIT TC KE"Pfi, CAN .JOB SIfiE":AT,.ALL TIMES.
Issued by •-
Date Comp l e ed l2 o �__ Inspected By
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR 3077
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm Con G Phone No.
�b ` �� •a(�q
Address of Firm
Location of proposed work a*C.v
Describe fully nature of permit requested
Starting date Y-/9-0/ Approx.time for completion a-/-o�
Call Before You Dig No. �27 Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North Prop. size of cut
No.cuts
Amt.of Deposit$ by
O Cash O Check#
Cut size after Perm. Patch
No. Cuts
Final Billing$
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: Date:
Title:
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc