HomeMy WebLinkAboutWater Street Cut Permits 673 Griffin Roa " APPLICATION FOR STREET EXCAVATION PERMIT
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE 25.00
Name of Firm �`—� ��nP � ern 5` 1 h c Phone No. 7
Address of Firm
Location of proposed work1G
Describe fully nature of permit requested
Starting date �/73o 7 Approx.time for completion_ / �R
Call before you dig no. 7_3 F-C90 7 / Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of So Wind$olr
two copies of separate drawing Pavement Cut
Indicate North /z/c, 0 el
Prop.size of cut
7 3 No. cuts
Amt.of Deposit$ by
i
Cash()Check#
Cut size after Perm. Patch
No.Cuts
Final Billing$
Amt. Due Payee $
J v.s/! 117�a/ „p VA i- �d�c
Amt. Due Town $
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: Date:
Title: A// cc,-L D.L.#__ / %-3 l 7 d�
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
Permit No.�* 2356 Town of South Windsor . CT
Date
09/25/1997 Street Excavation Permit
x
Expiration Date 09/25/ 1998
Descrip : TRENCHLESS EX.C'EVk-TION
Location
App 1 i cant
Name STATE LINE SEWER & Cuh Gii ifs Rt)AD
Addr. 236 SHAKER ROAD Tyke of- Wcr< WATER
ENFIELD CT 06082
Phone (860 )749-6176
Applicant agrees to furnish the Town of South i��ndsor the amount of bond
Town cif South Windsor, for any expenses
required and to reimburse the
incurred by the Town for ma i rtenance ar repay n wt�rh n' connection with this
permit and that applicant is familiar with and will abide by the rules and
regulations for permits as Outlined i n -the Xown,of South Windsor ' s Street
out Permit Manual .
�* ERMIT Tp ,BE KEPT aN JC16 SITE AT ALL TIMES. * '�
t
Title V
Issued by -- - , 114
Date- Complet' Inspected By
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