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HomeMy WebLinkAboutRestoration of MDV paving Street Cut Per (2) M APPLICATION FOR STRE``�T'kXCAVATION PERMIT TOWN OF SOUTH WINDSOR Amt. Bond Required S,oaO PUBLIC WORKS DEPARTMENT Amt. on File uau TOWN HALL [Date rmit Date of Expiration G-7—�j 1540 SULLIVAN AVENUE•Ins. on File (teYesNo SOUTH WINDSOR CT Expiration Date �/1- (� FEE $25,00tmit Expires_ �_Z9�9� Name of Firm A4 r¢ y7//'y Address of Firm ,-, s Z42 Phone No. —_ ' 9 Location of proposed work 66 ,-r��, ��,n S/�� Describe fully nature of permit requested Starting date Call before you dig No. S�� / �'I Approx. time for completion c��3 L/ o-L Traffic Services Control No Show sketch of proposed work or furnish To be Titled out by Town of South Wkxhm two copies of separate drawing OPavement 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 $ — Applicant is responsible for contacting Amt. Due Town $ the Police Dept. and C.B.Y.D. by date t agree fo funish to the Town of South Windsor the amount of bond required and to reimburse the Town of South Windsor for any.t xpenses incurred by the To for maintenance or repair work in connection with this permit and that I am familiar with and tiviH i b` he 'rul s aril regulations for permits as ou fined in the Town of South Windsor's Street Cut Permit Manual. f n Signed: Title: D.L.L.# Qate; r f' MfI .4'tIN . +IOBSng �1T ALL TIFAES' APPROVED: DATE:-3/Z,9 9r_ `T N INEER t�Sat vior t rted Date Completed .Z _ � ti • Date�7�i�_ YELLOW , ENGINEERING PINK - ST. SERVICES GOLDENROD FINANCE (10 foRa . Oaf r IS, --I�I' M^S !� ? J �O y10 O U J z yw •'• �LO R J 4a O y R SOLTy n Z4i 6 e-. a.. STR pr OR ti SqT U qRe FET Q / , smR '.Ri O q O eCC,TF R gORq ✓UOr a•• F��r yp2 ��G�o� J 7 °•90 7 � `SFr � - 6- •1 .�� O?•.._ � � \\\ �� MCO�E Oq ESt AVL N �gE�Op'[OON � B•- Ride /.-'�/+ l/ °��Tei © Q """q�J CTO' GO b L - •L +Bs _ - RCLE ES), n.1 xS�H Q m O 4`•, O n t OyOq ORO � RRY BROO Opp 0 PO ,`'► _ �9Y Ory K � R � p J Doi` y QO ro = W B" ro � SrCq a•• 11f1 I 11 %r -�w ty�� �•• MpR R�-V�F� lJngJ`ATEi s•. 7; 1 lr � A�Fq IZ.. JO • �� /� f a� aura xu +ro 3gNT A�r F RO�O � • • UT U�? 1 PO p Z p J • a OJ ' G4 • a- v ,3'`�G'c0� Cyq pFC � CqR� � 7CQ Y G 6 Cq f Fs • ` 'MARTY M `9 LA w -- �UGT!ONI --------- ----------- BLVO 1 �pSx ODN9 _ - .. _ Y \ m • RU�.eY 3 < J + + R Id • t. J t1 `+�