HomeMy WebLinkAboutWater Street Cut Permits 657 Griffin Roa TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 3801 Con>t'racto:r.,+CONNFCT'T'C:UT WATER COMPANY
Location 0657 GRIFFIN ROAD "Addpes`s i>`' 25 'tTORO
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Type Work WATER
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Permit No. 3801 Town of South Windsor, CT
Date 07/15/2004 Street Excavation Permit
Expiration Date 07/15/2005 " "•: "` `<>
Descrip: INSTALL WATER SER;V"ICE
Applicant ;Locatzon
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Name CONNECTICUT WAT.4R COMANX6S7, .GRIFFIII RQAth
Addr. 25 NORTH ROAD
EAST WINDSOR CT 46088 I 17e of :Mork A;TER
Phone (860)292-5552
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Applicant agreed to furnisli' the Tovtrk sf Swath Winbb Gheam6.nt of bond
required and to rei;mbuse.. the Tatvfrn ;.$oL�tYf A7zxxds:oroY any' e
r xpenses
incurred by the Towh fo sztaantnance or repair work eraonnect 'on with this
permi
t and that n P ica t
PP .:;. : s : . Wl.la;abade:..by the rules and
regulations for permits a.:s uutlinecl 3#� tia ', Yi�ai3x of South aiiclsor s Street
Cut Permit Manual.
* * PERMIT TO`'BE KEPT ON' FgB..53%� AT..,AII TINES.
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Date Completed -----—----___--- Inspected By
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm Phone No. ,j 3�a
Address of Firm
Location of proposed work
Describe fully nature of permit requested �-
Starting date Approx.time for completion
Call Before You ig o. Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out I&Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North Prop. size of cut
No. cuts
Amt. of Deposit$ by
()Cash ()Check#
Cut size after Perm. Patch
No. Cuts
Final Billing$
Amt. Due Payee$
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Amt. Due Town $
Applicant is responsible for contacting K
the Police Dept. and C.B.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: f ,
gj Date:
PERMIT SHALL BE KEPT ON]OBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc