HomeMy WebLinkAboutWater Street Cut Permits 689 Deming Stre . TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 2807 Contractor STATE LINE SEWER & CONST CO
Location 0689 DEMING STREET
Address 238 SHAKER ROAD
Type Work WATER
ENFIELD CT 06082
Phone No. (860)749-6176
Date Insp Needed
Date Insp.
Time Insp Needed _ Time Insp.'
Inspected By
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Input Date
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APPLICATION
OWON OF SOUTH EXCAVATION PERMIT
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm Phone No.
Address of Firm aZ1
Location of proposed work
Describe fully nature of permit requested ;
Starting date — Approx.time for completion —�
Call before you dig no. `Q 1 (�o 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
N Indicate North Prop.size of cut
No.cuts
Amt.of Deposit $ by
c?a-
(1 Cash(1 Check#
Cut size after Perm. Patch
No.Cuts
Final Billing $
Amt. Due Payee $
Amt. Due Town $
Applicant is responsible for contacting
the Police Dept. and C.B.Y.D. by date
I AGREE TO FURNISH TO THE TOWN OF SOUTH WINDSOR THE AMOUNT OF BOND REQUIRED AND TO R IIMBURSE 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.# ( (0
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES