HomeMy WebLinkAboutTo cut new street into Felt Road Street APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
Amt._ Bond R ire _ PUBLIC WORKS DEPARTMENT
Amt. on Fii rn 0 0 TOWN HALL Permit , N2
Date of Expiration ¢- 1540 SULLIVAN AVENUE Date
Ins. on File ( Yes O No SOUTH WINDSOR, CT Permit Expires -95
Expiration Date FEE $25.00
Name of Firm �f'f
Address of Firm Phone No. -Fo 45;� ' 0 4�
Location of proposed work
Describe fully nature of permit requested it J:f .�
Starting date �0 ' S~ Approx. time for completion
Call before you dig No. Traffic Services Control No.
Show sketch of proposed work or furnish To be tiled out by Town of South VAndsor
two copies of separate drawing
Pavement Cut
O Indicate North
/� ��✓' � Prop. size of cut
r . No. cuXk
V ,Amt. obyCa� Cut sizchNo. CuFinal BAmt. D }
Amt. Due Town $ _
Applicant is responsible-for contacting
the Police Dept. and C.B.Y.D. by date
I agree to funish 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: V Title:
O1-
D.L.L.# CIO9 S-/07 ` Datg
r.,
PERMIT 7SHALL BE At JOBSITE � TIMES
APPROV DATE:
t
TOW ENGINEER
FOR INSPECTOR: Date work started Date Completed
Signed Date _
WHITE - PERMIT PINK - ST. SERVICES
2 YELLOW - ENGINEERING—— __ -_._.;. GOLDENROD FINANCE