HomeMy WebLinkAboutWater Street Cut Permits 9 Gray Road Permit Nb. 22J0 -lown of South Windsor', CT
Date 11 /05/ 1996 Street Excavation Permit
Expiration Date 11 /05/ 1997
Descrip:
Applicant Location
Name CONNECTICUT WATER COMPANY 0009 GRAY ROAD
Addr. 25 NORTH ROAD
EAST WINDSOR CT 06068 Type of Work` WATER
Phone (, 860 )292-5552,
Applicant agrees to furnish the Town of South Winclsor the amount of bond
required and to reimburse ,tha Town of South Windsor for any expenses
incurred by the Town for ma:intenance 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 W-indsor' s Street
Cut Permit Manual .
"NPERMIT TO BE KEPT ON J09 SITE AT ALL TIMES,
-4,
Issued by )�t Title
Date Cornplpte6 Inspected By
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WIWO
, CT
FEE
Name of Firm LCa1)eCtj,P1jy WalcrI , Phone No. la�/.�- �� ✓�
Address of Firm - l'
Location of proposed work q Cj,,a.,z,j
Describe fully nature of permit requested d
Starting date �/ S- /n Approx.time for completion
Call before you dig no. Q�n�/�1r(��f�/�5 Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of So. Windsor
two copies of separate drawing Pavement Cut
Indicate North Prop.size of cut �j --
No.cuts
3
Amt.of Deposit t by
()Cash()Check 11
k-d
Cut size after Perm. Patch
No.Cuts
7
\ Final Billing$
Amt.Due Payee
Amt.Due Town 4
Applicant is responsible for contacting
the Police Dept. and C.S.Y.D. by date
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: l�/��,� �1, � 1 Date: -
Title:
' 11 D.L.N
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES