HomeMy WebLinkAboutWater Street Cut Permits 256 Felt Road APPLICATION FOR STREET, EXCAVATION PERMIT
TOWN OF SOUTH- WINDSOR
Amt. Bond-Required .- od PUBLIC WORMS DEPARTMENT -
mt. on File s'vu.G TOWN HALL Permit p
Datflf Expiration = 1.540 SULLIVAN 'AVENUE Date Z Z --
SOUTH WINDSOR CT Permit Expires i - r-
I`ns. on`File (iYes O No xp
Expiration Date c''� '.� FEE $25 00
Name of Firm CV, b f-0. C 6 N y FI-4 t.rl in,'
Address of'Firm "« �`�' Ps.. � .. n a'y �.�* C �.�GC ;
_ Phone No
Location of.proposed work
Describe fully nature of permit requested Aftt't'+VlG 1" 6 y,fcf
Starting date `' ' Approx. time for completion
as boor you dig No. Traffic Services Control No.
Show"sketch of proposed work or furnish To be filled out by Town of South YMindaor
two copies of separate drawing
Pavement Out
O Indicate North f 9)4 z 7V
' Prop. size of cut
4 No. cuts
.r
J.A Amt. of.Deposit by '
,.V O Cash ( Check #
a Cut size after Perm Patch
p, No. Cuts
Final Billing $
Amt. Due ayee $
l PAAJ 41+116 17` ! 0 Amt. Due Town $
Applicant-.is responsible for contacting
the Police Dept. and C.B.Y.D. by date
I, a0ree•to-funish to the Town of South Windsor the amount of bond required and to reimburse the Town of South Winds.Qr-
fof 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: A to ` Title: a W Nell
c
D.L.L.# \ Date: Ot_ z 1 ! 1 s
Pmary- SWLLL BE`KEF7 ON AT ALL TWES
APPROVEQ; DATE: �-
O 29
ENGINEERi¢H-�-�!)
s.
W.OR•INSPECTOR: Date work started Date Completed
Signed Date
WHITE.- PERMIT PINY - ST. SERVICES
--YELLOW ENGINEERING -_,,.. GOLDENROD FINANCE'_:.
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