HomeMy WebLinkAboutDriveway Street Cut Permits 195 Governor (2) Permit No. 3014 Town of South Windsor, CT
Date 08/14/2000 Street Excavation Permit
Expiratian Date 08/14/2001
Descrip:
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Applicant Location
Name DESIATO SAND & GRAVEL COAP ., J195GOVERNORS HIGHWA
Addr. 999 STAFFORD ROAD
STORRS CT 06268 Ype bf Work DRIVEWAY
Phone
Applicant agrees to f urn a th+ 'Yawn Cif Solitth W indsor the amount of bond
required and to reimturs thO Town Sci�t`h1nor. for any expenses
incurred by the Town fcr 04then�a�Cb �r ,r,epa xrh .i n connection with this
permit and that appl icantfi` 4- am7 � i � and�n :T,7 ? wide by the rules and
regulations for permits a a�tlna � T.o,t � �Suth Windsor's Street
Cut Permit Manual . 77
PERMIT K Pfi 4ON 0# S.ITE At, 'ALL TIMES.
�.
Issued by Title. '" � G �-t;l�
Date Compl to Inspected By
301�1
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSORF CT
// /FEE $25.00
Name of Firm d"" G Phone No. 6 y�
Address of Firm
Location of proposed work 1 rd e
Describ fully nature of permit r ested
JUM&W AV C aU it b 1
Starting date Approx.time for completion d
Call Before You Dig No. Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
�, Cut � SAe
Indicate North Pavement Prop. size of cut
c
No.cuts '.
Amt.of Deposit$ by
GO�tr pr wa O CashloCheck#
Cut size after Perm. Patch
No. Cuts
Final Billing$
Amt. Due Payee$
_ Amt. Due Town$
Applicant is responsible for contacting b
the Police De y t.and C.B.Y.D. date
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: �— Date:
Title:_ /6
PERMIT SHALL BE KEPT ON]OBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc
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