HomeMy WebLinkAboutWater Street Cut Permits 154 Griffin Roa (2) APPLICATION FOR STREEt'EXCAVATION PERMIT
TOWN 44P SOUTH WINQSOR
Amt. Bona Required �.; PUBLIC / RKS ADEPARTMENT
Amt. on File T W� HALL Permit 1 Date of Expiration 15�+40 SULLI.V' 77
A AVENUE Hate t�
~Ins. on File (ij�*es O No SOUTH.WINDSOR, CT Permit Expires — —Z -y
Expiration Date FEE $25.00
Name of Firm
Address of Firm 3 Spa st Lf° �'?� Phone No.
Location of proposed work
Describe fyUy nature of ,permit requested _
Starting date " y G lT --
fel 70/ 7� Approx. time for completion
Cal before you dig No. Traffic Services Control No.
Show sketch of proposed work or furnish ` T_c be Ivied aut by Town of ;gM yyt
two copies of separate drawing L � '
`Ind' Pavement Cutate North 'A/ // /
/
00 AJ
Prop.p. size of cut _
No. cuts
Ir$C/ Amt. of Deposit $ by
{ ) Cash O Check #—
Cut size after Perm Patch
I No. Cuts
Final Billing,$
rt�Q
Amt. Due Town $ -�
Applicant is responsible for contacting
the Police Dept. and C.B.Y.D. by date_
i agree to funish to :the Town of South Windsor the amount of bond required and to reimburse the Town of South Windsor I
for any.,,.experiee's 1ridWid by the Town for maintenance or repair work in connection with this permit and that I am
femiliar w . d will `abi the rules and regulations for permits as outlined in the Town of South Windsor's Street Cut Permit Manual.
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$gnec(,7 Title:
D L L t"l 3 Date
'OM T ALL TIt1S
APPFt1/E DATE:
TO GINEER
tdo Date"work started Date Completed
Date - f
00,
WHITE° PMIT PINK ST. SERVICES
YELL01N ENGINEERING rr�' GtSLDENROD - FINANCE
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