HomeMy WebLinkAboutDriveway Street Cut Permits 140 Farmstea Permit No.
� Date 3830
08/23/2004 Town of
South Windsor, CT
Expiration Date 08/23/2005 "` ;` y Street Excavation Permit
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CURB CUT FOR z6S
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permit and that a 1*k: t ?ance or"Yp`air:z:,>:<:>>5,f•'.:rx>::., :?„arid' '€Phses
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for permits az ,. ��� 2vi3 y„,r rules th this
Cut Permit o finedye ��c of3�xci " b th`e and
Manual. Sq{t
1W4. ' or l s Street
PERMIT TO
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lulu rUtt 5 I► K.EET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT Permit No.
TOWN HALL
Lc 1540 SULLIVAN AVENUE
L`.I-
SOUTH WINDSOR, CT 06074
]] FEE $25.00
Name of Firm err^hr✓
Address of Firm Phone No.
Location of proposed work '1/o
Describe fully nature of permit requested
Starting date 3 `>
Call Before You DigNo. �����Pprox- time fo�oomp�letion C'0 35 �" ` Cj rIN
Traffic Services Control No.
Show sketch of proposed work or furnish
two copies of separate drawing Indicate North This section to be filled out by
Town of South Windsor
Pavement Cut
No.cuts
Est..Size of Perm.Patch(s)
Est.Pvt.Thickness in.
Est.Unit Price$
�y.. Amt.of Deposit$
Total Due$ by
Aj
( )Cash( )Check#
Permanent Patch .
No. Cuts
Size of Patch(s)
Final Billing .
Amt.Due Payee
C/
Amt.Due Town
`r $
By
Applicant is responsible for contacting the Police Dept.and C.B.Y.D. Date
I AGREE TO FURNISH TW
F SOUTH WINDSOR THE AMOUNT OF BOND REQUIRED AND TO REIMBURSE THE
TOWN OF SOUTH WI EXPENSES INCURRED BY THE TOWN FOR MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH E HAT I AM FAMILIAR WITH AND WILL ABIDE BY THE
PERMITS AS 0 I D SOUTH WINDSOR'S STREET CUT PERMIT MAN A RULES AND REGULATIONS FOR
L.
Signed: tf .� `/
Date:
Title: 'L�i'
Driver's License#:
PERMIT SHALL BE KE T ON JOBSITE AT ALL TIMES