HomeMy WebLinkAboutStorm Street Cut Permits Cornerstone Dri 4. Town of South Windsor . CT
Permit No, 2870 �: Street Excavation Permit
Date 091/20/ 1999
Expiration Date 09/ 19/2000
Descrip CATCH BASIN I�` AVERY STREET
je . 6 Location
Applicant
ECHO FARMS ...4311��' DRIVE AT AVERY ST
Name SIMSCRO��'
Addr . P .O. BOY: 581 Type of Work STORM
SIMSBURY OT 06070 ;
phone (860 )651-0231
Applicant agrees
to furnish the TcaWn of South W1nd�oran�eeX�ensesof bond
required and to reimburse the Town of South Windsor fide by the rules and
d b ,he Town for maintenance or ,repair wo
wilrk in l abide connection with this
incurre � � , ant is fami11 liar with a
permit and that app , c
re ulations `or permits' as outlined in the Town of South Windsor s Stree
9
Cut Permit Manual ,
* P Ph�IT TO = KEPT ON JOt3 SITE. AT, ALL TIMES .
Tide
Issued by Z ,
r c f nspected By
Date Comp 1 e�t ee#�
F ARLI�ATION FOR STREET .EXCAVATION PERMIT
TOWN 'OF SOUTH WINDSOR
RU1 LIC WORKS DEPARTMENT
F
TOWN HALL
1 4
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm Phone No.
Address of Firm ram' R4c
Location of proposed work p
f Describe-fully-nature of permit requested -j eek c,.d New s
Starting date Approx.time for completion-- S
Call Before You Dig No. Traffic Services Control No.
Show sketch of proposed Work or famish To be filled out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North Prop.size of cut X� / 36-W
� �13i`7/JlStp,�v �Ll � No.cuts__JF_�
Amt.of Deposit$ .I.zd'24 by G
O Cash{check# [ bZ .
Cut size after Perm. Patch
No. Cuts
Final Billing$
Amt. Due Payee$
Amt. Due Town$
t` 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--- D.L.#: OG 2G g�f�
PER
MIT SHAL
L BE KEPT ON]OBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc______
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