HomeMy WebLinkAboutWater Street Cut Permits 518 Graham Road TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 3047 Contractor CONNECTICUT WATER COMPANY
Location 0518 GRAHAM ROAD Address 25 NORTH ROAD
Type Work WATER EAST WINDSOR CT 06088
Phone No. (860)292-5552
Date Insp Needed Ra ` Insp.
Time Insp Needed finsp:
Inspected By ►�[(
Work in Progress ,1�.�n-`?mot l+ ( 4� ,1 Win, --E;a-,r-R AN --4zC0rAPL,'j.E
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Input Date
Permit No. 3047 Town of South Windsor, CT
Date 11/07/2000 Street Excavation Permit
Expiration Date 11/07/2001
Descrip:
Applicant '
Location
Name CONNECTICUT WATER COMOANY GRAHAM ROAD
Addr. 25 NORTH ROAD '
EAST ,WINDSOR CT 0. k =WATER
Phone (860)292-5552
Y ti at 3
Applicant agrees toys � `thy 4 Windsor the amount of bond
required and to reimbue� 'Ye: Tot� � th Wr �`for any expenses
incurred by the Town f'o-r ,, ten or; r*pair work An connection with this
permit and that appl i at 1•i� tr 1y and "abide by the rules and
regulations for permits a q�- 'mil tfh °t�� �� o South Windsor's Street
Cut Permit Manual . ;
* PERMIT T tE KEP,,T N ,j� .81TE ATT''ALL TIMES.
Issued by fi,.tl..d'
Date Compl to I
--�
---�-- nspected By� .
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F
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm
Phone No._&a3-
Address of Firm
Location of proposed work
Describe fully nature of permit requested li7
Starting date ,�/- Approx.time for completion
Call Before You Dig No. Traffic Services Control No.
Show sketch of proposed work or furnish To
two copies of separate drawing out by Town of South�Ilindsor
Pavement Cut
Indicate North Prop.size of cut
No..cuts
Amt.of Deposit$ by
{)Cash O Check#
Cut size after Perm. Patch
No. Cuts
Final Billing$
__.__-__ __ ._..____........
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'SSTREET CUT PERMIT MANUAL.
----Signed Z� 4 Q _
- Date: �-
Title: a,h D.L.#:
PERMIT SHALL BE KEPT ON 3013SITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc