HomeMy WebLinkAboutStreet Cut Permits Foster Street, Slater APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
Amt, Bond Required PUBLIC WORKS DEPARTMENT
Amt. on File TOWN HALL Permit , 2 o
"gate of Expiration 1 540 SULLIVAN AVENUE Date
Ins. on File O Yes O No SOUTH WINDSOR, CT Permit Expires
Expiration Date FEE jg wWA)0 )6--
Name of Firm C} ' a!v 0^pot
Address of Firm- ZrS- NUv*Vn Qcr.. 0 U&4- 6 'hone No. --".qZ. 15 S 7
Location of proposed work V*Q t 1✓' 1. 7—CA D¢y�'1lr�>I n!i
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Describe fully nature of permit requested Z 1600 \Z .I, C�'G tcJ1t«►►�1
Starting date ( CI Approx. time for completion > eC
Call before you dig No. Traffic Services Control No.
Show sketch of proposed work or furnish To be filled aut by Town of South YVfindsor
two copies of separate drawing
Pavement Cut
O Indicate North
Prop, size of cut
4r7n,-
No. cuts 1 —
V
Amt. of Deposit $ I Z�069.A) by
r � ( ) Cash (y�Check # I � �
Cut size after Perm Patch
No. Cuts
r:
Final Billing $
Amt. Due Payee $ —
* F Cj*Z L Qt Amt. Due Town $ -_
Applicant is responsible for contacting 1'Eww rr 7,1
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 incurr, d by the Town for maintenance or repair work in connection with this permit and that I am
familiar with and will a ide by the rules and regulations for permits as outlined in the Town of South Windsor's Street Cut Permit Manual:,
Signed:, Title: ,d"'t' 0 19s
D.L.L.# i 47. V 4J (00 Dater
PERMIT SWILL BE 118'T ON JOBSITE AT ALL TU1ES
APPROVED: DATE:
TOWN ENGINEER
FOR INSPECTOR: Date work started Date.Completed
Signed Date
WHITE - PERMIT PINK - ST. SERVICES
YELLOW - ENGINEERING "" GOLDENROD - FINANCE
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