HomeMy WebLinkAboutMiscellaneous Street Cut Permits 285 Dem ermi t, No. . 24122,2 Town of South Windsor- , CT
Ate 04/231/ 199R Street Excavation Permit
xpiration Date. 04/2U/ 1999
escrip:
App I i cent Li�c-at.i on .,
ame WILCOX EXCAV . CON . CO. Ci ERRY). OJ 85 OEM rN(3 STREET
ddr .. 71 W7 [_L_t>W STREET '
SOUTH WZNDS%)R CT glut 74 Ty1e �ot Work MISCEL_LAN
hone (860 )644-8534
Applicant agrees to f0 r,na.s:h' 't;ha .Town of Sou t,
, ,h, ,Windsor the amount of bond
required and to reimburse thee Town of South Wind$or for any expenses
incurred by the Town for, rttainte.nance or repair work'' rn connection with this
permit and that app l icanr, is >farni I i a r with and wi1'1 abide by the rules and
requ 1 at i ons for, per m i is as out 1 i rued 4 n 'the Town of South Windsor ' s Street
Cut Permit Manual .
>= FRM11' id BE EPT UN SITE'. AT ALL TIMES. * �
Issued by � -L i t 1 e
� L
Date Corny I e GecJ _.__ _ ----_ _.-- I nspet;ted By
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 i,��/ ,� i�l F Phone No. 1l44 "
Address of Firm �] J��Et(u car. < r— 4r,. (�f, IEv►/� S�lZ (', 1'
Location of proposed work' n ,_ / �• Sr9 (vle`nee S ae
Describe fully nature of Sr permit requested A)(Z ^ W N6�� z.L Ae IV I Z 70 20 P. nJ� LZ � 7rL./t(-
Starting date �/ Z 3 Z IApprox.time for completion
Call before you dig no. � ��� J � — 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
C4L
No.cuts
Amt. of Deposit S by
O Cash O Check#
Cut size after Perm. Patch
t
No.Cuts
` Final Billing $
Amt. Due Payee 3
Amt. Due Town 8
Applicant is responsible for contacting
the Police Dept. and C.S.Y.D. by date
I AGREE TO FURNISH TO THE TOWN OF SOUTH WINDSOR THE AMOUNT OF BOND REQUIRED AND TO R eMBURSE 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.
Big Date: �(
Title: /ljsti� _ D.L.B
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES Z �( U