HomeMy WebLinkAboutWater Street Cut Permits 239 Felt Road Permit No.
Date `l�2
�04/ 1 '1 ;2a�7i�
+ Own of Soutn Windsor. C,-
Expiration '"Date D4,! j1 Street Excavation R r
Descrip: 2i�Gi e mIt
Anp i cant
Name COVEN CONSTRUCTION Co Addr. P. D. l_ncat'ion
BOX 427
COVENTRY CT u.23S FELT" ROAD
Phone ( 880 )282- D6238
C75�r�5 . Type pf Wark WADER
Applicant agrees t
required and o i'urh1sh' the
to reimburse tale 'Town ,of
fW' of SOuth W;
Permit ed by the Town for SOuth Winds' '
Windsor the
maintenance or Or for amount of bond
anc that applicant repair any expenses
'_egu l at i ons for s farm"7 i'ar Will °i n connection w; th this
Cut R permits as out1'�n with and Will in
by t
Permit Manual , ed 1'n the he rules and
TOwrY of -outs; W-indsor 's Street
* PERMIT To BE N,EP T CN JG� SITE Issued by �c'a6? AT ALL TIMES.
Oat -_-. : w_ T-i t l e --
e Completed
----_--._ - Inspected By - ----
APPLICATION.FOR STREET EXCAVATION PERMIT
_ TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
n
Name of Firm O U Z-,nJ d 1 A C, Phone No. � �(dt y 6
Address of Firm o No
Location of proposed work
Describe fully nature of permit requested
Starting date Approx.time for completion 2 0,0 7
Call Before You Dig No., Traffic Services Control No.
Show sketctr of proposed work or furnish To be filled out by Town of South Windsor
two.copies-of separate drawing
Pavement Cut
Indicate North Prop. size of cut r' ez, —
rA�'
No.cuts i
Amt.of Deposit$ !Z O. Z y by
O Cash Check# s�/ 7/
Cut size after Perm. Patch
No. Cuts
Final Billing
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. PENSES INCURRED BY THE TOWN FOR MAINTENANCE OR REPAIR WORK IN CONNECTION WITH THIS.
PERMIT AND THAT I M F ILIAR WITH AND WILL ABIDE BY THE RULES AND REGPLATIONS FOR PERMITS AS OUTLINED_IN THE
TOWN OF SOUTH _ SO STREET CUT PERMIT MANUAL.
Signed: Date: UO
ff
Title:- D.L.#: a2 d h l
PERMIT SHALL BE KEPT ON]OBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc