HomeMy WebLinkAboutWater Street Cut Permits 635 Graham Road TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 3741 Contxactor COIdNE'CT<I:CUT WATER COMPANY
Location 0635 GRAHAM ROAD
Address* 25 NORT::. RCy'A:U..
Type Work WATER EA,$T W7NDSOR CT:: 06088
Phone No f 864)2y2�`5552 :,.
Date Insp Needed
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Time Insp Needed
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Inspected By 'Q �
Work in Progress
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r Permit No. 3741 Town of South Windsor, CT
Date 05/28/2004 Street Excavation Permit
Expiration Date 05/28/2005
Descrip:
Applicant LoGt: on
Name CONNECTICUT WATER COM,,ANY..,.. D63" GRAHAT4 ROA19
Addr. 25 NORTH ROAD
EAST WINDSOR CT 06Q88 type �hf Wov. WATER
Phone (860)292-5552
Applicant agrees to fUj .fr�ash the T,cawn oL vu ,h Winds:x tYiiiii� e amount of bond
required and to reimburse the -Town of spwth T�7i visor Ear any expenses
incurred by the Townr maintentsee; or repa�,� work ct5nesion with this
permit and that applicaxat as f.amilia':s with and ;v11 a'k� de by the rules and
regulations for permits 'as. outaed:;az .the Town a:;of' So:utnds r s Street
Cut Permit Manual.
XX
* * PERMIT IO $E' K$P1 OI7 yTi3 Z$ A A ,L ,T1Mh5 ,"*
Issued by ----- !� Title
— ---------
Date Completed _---__— Irxspectd By
----- f��--------
MAY. 28. 2004 10:08AM CONNECTICUT WATER CO N0. 880 P. 1
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR /0
PUBLIC WORKS DEPARTMENT
TOWN HALL,
1540 SULLIVAN AVENUE
SOUTH WINDSORf CT
FEE $25.00
Name of FirmWA Phone No. Ld o2.� ,�3 5 S x 33 a
Address of Arm
Location of proposed work--
Describe fully nature of permit requested ,e
Stargng date Approx.time for Completion
Call Before You Dig No. Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out hV Town of South W' dsor
two copies of separate drawing
Pavement
Indicate North Prop,size of cut
2� No.cuts
J Amt. of Deposit$ by
()Cash()Check#
Cut size after Perm. Patch
��Nl• No. Cuts._
Final Billing$
Amt. Due Payee$
K.r 44 AM JtD Amt. Due Town$
Applicant is responsible for contacting by date
the Police Dept. and C.S.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: Date: L Q'7
r
Title:
PERMIT SHALL BE KEPT ON JOBSIrE AT ALL TIMES
Standard Forms\Permits\Sixeet Excavation Permit,doc