HomeMy WebLinkAboutSanitary Lateral Street Cut Permits 574 / TOWN OF SOUTH WINDSOR INSPECTION REPORT
PeFmit No 3438 Contractor BARBER UTILITIES L. L . C.
Location ri Address P.O. BOX 331
Type Work lElMS"A - ELLINGTON CT 06029
No. (860)872-2330
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Date Insp Needed .04
3)30 PM
Time Insp Needed
Inspected By
Work in Progress
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Permit No. 3438 Town of South Windsor, CT
Da'jOb 01/06/2003 Street Excavation Permit
Expiration Date 01/06/2004
Descrip:
Applicant 0 S 41Location
Name BARBER UTILITIES L. L L OAD
Addr. P.O. BOX 331
ELLINGTON CT 06029 E EW SAN LAT
Phone (860)872-2330
10 Applicant agrees tCuh iht or the amount of bond
required and to reim o ` th r any expenses
incurred by the Town enan pal i connection with this
permit and that appli an ide by the rules and
regulations for permi li "'" th Windsor' s Street
Cut Permit Manual .
* * PERMIT T r L TIMES.
Issued by C.1kjX
Date Completed Inspected By2. Cc �
�3433
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm — , _-> , r L-7n Li 1-�(—s Phone No. y
Address of Firm 3
Location of proposed work 5 72 FED 1- P D
Describe fully nature of permit requested S ic/
Starting date ( -2-— 'Z° Approx.time for completion <p,y,- 'v
Call Before You Dig No. Z c,el ZS j c 177 .' Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North Prop. size of cut
L, No.cuts
1 Amt.of Deposit$ by
()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 7SOUTWINDSOR'S ST ET CUT PERMIT MANUAL.
Signed: Date:
Title: D.L.#: z 7 e 5 S -7
PERMIT SHALL BE KEPT ON JOBSITE A'T ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc