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HomeMy WebLinkAboutWater Street Cut Permits 827 Ellington R Town of South Windsor ., CT 2999 Street Excavation t'ermit Permit No. �i8/��Z 2000 - Data ExpirationDapATCH/02/L001 Descrip: MD � • Location Applicant 0627' ELLINGTON ROAD Name J . G. CONSTRUCTION CO. N M. ame . 2fi MOiJTROSE ST Type of Work WATER AddrHARTFORD C 06106 Phone ( 860 )953-8025 Of South Windsor the amount of bond Applicant agrees to Furnish the ow expenses ©r repair work in connecthenrules and with 11 required and to reimburse` trie Townoef South Windsor for anb incurred by the Town for "I.s f maintenance that app� icant is Fame l iain�the Towrswaf� SouthevJindsor' s Street permit and far permits as out�lvned regulations Cut Permit Manual . PERMIT T BE KEPT' ON JOB, SITE AT ALL TIMES . issued b y e d B Inspect x Date Comp l eteG ----------- r a55 APPLICATION FOR STREET EXCAVATION PERMIT TOWN OF SOUTHVINDSOR PUBLIC WORKS DEPARTMENT TOWN HALL 1540 SULLIVAN AVENUE SOUTH WINDSOR, CT FEE $25.00 \I Name of Firm ® 1 c Ph ne No.960 Address of Firm 216 Location of proposed work 7 Describe fully nature of permit requested Starting da Approx.time for completion Call Before You Dig No. Traffic Services Control No. Show sketch of proposed work or furnish To be filled out by Town of South Windsor two copies of separate drawing Pavement Cut Indicate North Prop.size of cut No.cuts Amt.of Deposit$ by O Cash 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 De t.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: o ? a'o Title: PERMIT SHALL BE KEPT ON 30BSITE AT ALL TIMES Standard Forms\Permits\Street Excavation Permit.doc