HomeMy WebLinkAboutWater Street Cut Permits 1017 Foster Str Permit No. !2679 Town of South Windsor, CT
Date 05/07/1999 Street Excavation Permit
Expiration Date 05/06,i2000
Descrip: WATER SERVICE
Applicant
Location
Name STATE LINE SEWER & 0045T �{
1CA 7 : FOSTER STREET Addr. 238 SHAKER ROAD
ENFIELD CT 06082E o&,Wai ,k WATER
Phone ( 860)749-6176
Applicant agrees to furn sfa� the' Town � 61f,"Souti� Windsor the amount of bond
required and to reimburse the,"Tow ,of Borth W-`'ha4Cr; fc r any expenses
incurred by the Town for maintenance o ,repai � �. -in connection with this
permit and that applicant , 's fami�T":�rxr with.,and� w� 1i ' abiae by the rules and
regulatigns for' permits as Outlined Jn ' the 'Tlt�
Cut Permit Manual o cat youth Windsor ' s Street
.
* * PERM; 7O 8E KEPT;" 3N JAB 5I'1`E ,AT , ALL TIMES.
Issued by
j-
Date Completed
___._ � -q- 'Inspected By
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm d,,ov jr Phone No. ?�r�-' /70
Address of Firm
Location of proposed work .
Describe fully nature of permit requested
Starting date Approx.time for completion
Call Before You 6ig No Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North Prop.size of cut
No.cuts
Amt.of Deposit$ by
Fo•r 7—weA 00-0 se
OCash OCheck#
Cut size after Perm. Patch
No. Cuts
Final Billing$
A7fit DtI�
Amt. Due Town
Applicant is responsible for contacting by o 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 SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed y�Y/ Date-
Title: D.L.#:
PERMIT SHALL BE KEPT ON]OBSITE AT ALL TIMES
Standard Forms\Permits\Street.Excavation Permit.doc