HomeMy WebLinkAboutWater Street Cut Permits 494 Graham Road TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 3614
Location
CorA,tractor CONNECTICUT WATER COMPANY
_
Type 'Work WATER a„ Add.reS� 25 NgR1H ROAD.,
BAST WINDSCR CT:;:06088
�7 Phone; No :($�4)292 5552'`
Date Insp Needed -- r P�[.�✓ /
Date <Insw_
Time Insp Needed
-------- Time Ijy
771
Inspected By
Work in Progress. ?
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Input: Date
Permit No. 3614 Town of South Windsor, CT
Date 10/16/2003 Street Excavation Permit
Expiration Date .10/15/2004
Descrip: INSTALL WATER SERVI CE
Applicant Lo.cat,�on
Name CONNECTICUT WATER COMPATIy 09, GRAHAMOAI]
Addr. 25 NORTH ROAD
EAST WINDSOR CT 0:608$' TY?e.. of W�irk W}pT
Phone (860)292-5552
Applicant agrees to furnish the TEtwf. Sozzth Windsor the ,arna.'unt of bond
required and to reimburse .tI1e Town �rf Sbpth .Wzndsa;r: for aiy expenses
incurred by the Town far ftia3,Atenance or repair work' xn cpnb pt on with this
permit and that applioant is fanii']sa .uxta will;. abide by t;he rules and
regulations for permits a s at tl fined n the TtSr ''af South,,;, t�aidsor's Street
Cut Permit Manual.
* * PERMIT TO 'BE ICEP •.;ON'3B 'SIPE" AT AIL TIMES.
Issued by
Date Completed Inspected B _ p�
APPLICATION FOR STREET EXCAVATION PERMIT �-361¢-
TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT 06074
FEE $25.00
Name of Firm C— .(J 7G l Phone No.
Address of Firm O�" O�,
Location of proposed work /4�j��6/
Describe fully nature of permit requested &,(AytV-iW 7
Starting dated "�cS'u : Approx. time for completion
Call Before You Dig No. Traffic Services Control No.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
Pavement Cut
No.cuts
0 Est.Size of Perm. Patch(s)
/�Wi}�flCia!/h/u
Est. Pvt.Thickness in.
Est. Unit Price$
Amt.of Deposit$
Total Due$ by
( )Cash( )Check#
Permanent Patch
No. Cuts
Size of Patch(s)
Final Billing
G�aC $
$Amt. Due Payee
Amt. Due Town
By
Applicant is responsible for contacting 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 'OUTLINED IN T TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signe G2 Date:
Title: Driver's License#:
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES