HomeMy WebLinkAboutWater Street Cut Permits 786 Ellington R Permit No. 3003 Town of South Windsor, CT
Date 08/02/2000 Street Excavation Permit
Expiration Date 08/02/2001 �
Descrip: MDC PATCH a
Applicant Location
Name M. J . D. CONSTRUCTION CO. 0786 ELLINGTON ROAD
Addr. 26 MONTROSE ST
HARTFORD CT 06106Type of Work WATER
Phone (860 )953-8025
Applicant agrees to furnish 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 applicant is 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 .
PERMIT TO ,BE KEPT ON JOS .SI`TE AT ALL TIMES.
Issued by TitleV_;_
Date Coma l eted .. Inspected 8y
Y
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
.FEE $25.00
Name of Firm _Tc�c< Pho a No,
Address of Firm
Location of proposed work
VAC 6 /
Describe fully nature of permit requested
Starting dater o 77 6 o Approx.time for completion
Call Before You Dig No. Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North Prop.size of cut
No.cuts
Amt.of Deposit$ by
O Cash{)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: y
PERMIT SHALL BE KEPT ON 70BSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc