HomeMy WebLinkAboutWater Street Cut Permits 77 Foster Road (2) i
TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 3426 Contractor MDC
Location '`Fted * Address P.O. BOX 800
Type Work WATER HARTFORD CT 06142
e No. (860)278-7850
Date Insp Needed n 1/1 o
. Time Insp Needed `0 A
Inspected By
Work in Progress
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I UM% Date a o�
jDer lit No... 3426 Town of South Windsor, CT
Da 10/30/2002 Street Excavation Permit
Expiration Date 10/30/2003
Descrip: REPAIR WATER MAIN LEAK
Applicant 0 Location
Name MDC 5o ROAD
Addr. P.O. BOX 800
HARTFORD CT 0614 WATER
Phone (860)278-7850
Applicant agrees t t Win sor the amount of bond
required and to rei T .uth 4 or any expenses
incurred by the Tow ter�� , w epa k 'n connection with this
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permit and that appl ' n +' a i bide by the rules and
regulations for perm t °'" outh Windsor's Street
Cut Permit Manual . t '
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* PERMIT ALL TIMES.
Issued b �J
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Date Completed Inspected By ' =• ,G.
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--� - Phone No. �C " " � �J�:' 4—5
Address of Firmyf� 07-
Location of proposed work , R 00
Describe fully nature of permit requested
,1t Starting date_ /0 - -qo -�L Approx. tirne for completion
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kCell before you dig no• - f
=- �.S r/ T+affic Services Control NO.
Show sketch of proposed work or furnish To be filled out by Town of So. Windsor
two copies Of separate drawing Pavement Cut
indicate Norih
Prop- size of cut
No. cuts ^
Amt. of Deposit t by
II Cash l} Check#
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/ 0 —3 +rJ M Cut size after Perm. Patch
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No. Cuts
Final Bil[iV S
Amt. Due Payee i
Amt.Due Town $
Applicant is responsible for contacting
the Police Dept. and C-B.Y.D. by date
1 AGREE TO FURNISH TO THE TOWN OF SOUTH WINDSOA THE AMOUNT OF MONO REQUIRED AND TO RQIMSURSE 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 WINOSOR'$ STREET CUT PERMIT MANUAL.
Signed: _ _ Date: ,/CI ".•j G'.� e,7 '?
Tide: D.L,#
PERMIT SHALL BE KEPT ON.IOBSITE AT ALL TIMES
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