HomeMy WebLinkAboutWater Street Cut Permits 130 Hayes Road v TOWN OF SOUTH WINDSOR INSPEC2;Lf ,;,.; ,P;QRT
Permit No. 3902 :,.} e<.:.y'rc",<..
BARhslE4r='UT LTI.IES L.L.C.
Location 0130 HAYES ROAD
Type Work WATER
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Permit No. 3902 Town of South Windsor, CT
Date 03/17/2005
Street Excavation Permit
Expiration Date 03/17/2006.
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4 fe',Tow£: 5 ? a"i%Fa'ieabr.:fi :> 'ny expenses
incurred by the Tows}
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permit and that appi3cant " s„ .atx `
`:� �:;T%. (�S�`C!�;'"`'f'���`:v>�'Y'� ``�}a.�'d� by;:the rules and
regulations for perm ' s Windsor s Street
Cut Permit Manual.
* * PERMIT TO V'BE KE.i�T> QYN„'JOB SITE:;Avz'iALt
Issued b "'• "' "'' "'�
-----------------
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Date Completed ---------- --- Inspected By _�� --
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT Permit No.
TOWN HALL
1640 SULLIVAN AVENUE
SOUTH WINDSOR, CT 06074
FEE $25.00
Name of Firm J ,2 G�i//mil GCS L 1
Address of Firm 3 y,�N�c Phone No. 6 7 Z — Z 33 v
Location of proposed work
Describe fully nature of permit requested ytJ ".J
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Starting date 3
Call Before You Dig No, Zoo /zo j ry� S" A time for completion
Traffic
Services Control No.
Show sketch of proposed work or famish
two copies of separate drawing Indicate North This section to be filled out by
Town of South Windsor
Pavement Cut
No.cuts C�
Est.Size of Perm.Patch(s)
� 13a
Est.Pvt.Thickness in.
Est.Unit Price$
Amt.of Deposit$
Total Due$ by
GIL ( )Cash( )Check#
Permanent Patch
No. Cuts
.............. .
Size of Patch(s)
Final Billing
Amt.Due Payee
Amt.Due Town
Applicant is responsible for contacting By
the Police De t.and C.B.Y.D. 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 TH THIS PER ND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR
PERMITS AS INED IN T T WN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: -
Date:_ 3 —,, 7-o
Title: C60"/z./r
Driver's License#: o 'Y 2 Z? F3S .3
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES