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HomeMy WebLinkAboutWater Street Cut Permits 431 Governors H Date 08/02/2000 -�©a'� Street Excavation Permit Expiration Date 08/02/20G1 Descrip: MDC PATCH Applicant Location Name M.J . D. CONSTRUCTION CC. 0431 GOVERNORS HIGHWA Addr. 26 MONTROQiE ST HARTFORD CT 06106 Type of `Work WATER Phone (860 )953--8025 Applicant agrees to furnish the Town of South 'Windsor the amount of bond requ- red 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 applicant' is 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 . * * PERMIT TO BE KEPT 'ON JOB SITE AT ALL TIMES . Issued by �'�� __-_ Title Date Completed Inspected By 4]n yw.'it Al s. 'JnnA Tr... ro �� Ln ,}6. 1li ror'1 e+r.r fT �®oy APPLICATION FOR STREET EXCAVATION PERMIT TOWN OF SOUTH -WINDSOR PUBLIC WORKS DEPARTMENT TOWN HALL 1540 SULLIVAN AVENUE SOUTH WINDSOR, CT FEE $25.00 Name of Firm Occ U Pone No. 6o-QS' i+�n �' Address of Firm p Location of proposed work p r Describe fully nature of permit requested Starting date D o'7- Approx.time for completion Call Before You Dig No. :1 o o® o 4 6.Traffic Services Control No. Show sketch of proposed work or.fumish To be filled out by Town of South Windsor two copies of separate drawing Pavement Cut Indicate North Prop. size of cut No.cuts Amt.of Deposit$ by O Cash O Check# Cut size after Perm.Patch No. Cuts Final Billing$ Amt. Due Payee$ Amt. Due Town$ Applicant is responsible for contacting by 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: D_a � U- te•. - Title: ao PERMIT SHALL BE KEPT ON 3OBSITE AT ALL TIMES Standard Forms\Permits\Street Excavation Permit.doc