HomeMy WebLinkAboutRepair sewer lateral Street Cut Permits (2) 1
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
Amt. Bond Required: sWoo PUBLIC WORKS DEPARTMENT
Amt. on File r000 TOWN HALL Permit ` a
Date of Expiration 1540. SULLIVAN AVENUE Date _ er
Ins. on File (of Yes O No SOUTH WINDSOR, CT Permit.Expires r
Expiration Date y-/�P 7► FEE $255.00
Name of Firm D
Address of Firm OInA Phone No. --7,1.7-9-so o
Location W proposed work /0/ A!2le.4"'D AIE:'
Desltccribe full"`nature of permit requested C V�'--�'.� O- G- T4 _C'A jr, O
Starting date 4"//0/V C Approx. time for completion
Call before you dig No. V"yio'e «Z Traffic Services Control No.
Show sketch of proposed-work or furnish To be tied out by Town of South Wbxbm
two copies of separate drawing
Pavement Cut
0 Indicate North
Prop. size of cut
No. cuts
Amt. of Deposit $_. y9�.r0 by
ser/o
{ ) Cash (eCheck #- Z
Cut size after Perm Patch
No. Cuts
�'�'•.'"'" -- N/6LSiDE Final Billing $
Amt: Due Payee $'
Amt. Due Town $
Applicant is responsible for contacting
the Police Dept. and C.B.Y.D. by date
,i, agree;-to funish to'`ine Tavrn of South Windsor the amount of bond required and to reimburse the Town of South Windsor
{br I any,expenses incurred by the Town,for maintenance or repair work in connection with this permit and that 1 am
familiar with'arrd .wilf abide by the rules'.and regulations for permits as outlined in the Town of South Windsor's Street Cut Permit. Manual.
Sig,i4 br6E Title:
Date: $"'
Ilan .dui i. lid i w AT ALL TES
APPROVED' ' .�ssw DATE:
�4
TaYK ENGI EER
Date sw,prk started Date Completed
-
WHITE PirRM17` PINK - ST. SERVICES
YELLOW:, ;fNGINEERiNG ""4k`>;; GOLDENROD FINANCE S;
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05/09 '96 07:25 ID:CALIL- BEFORE YOU DIG FAX:203-248-6448 PAGE 1
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EMERGENCY MLH--09 05/09/96 07114i15
REQUEST NO. - 961901562 TIMR-07c09 DATE. .05/09/96
TOWN. . . . .. . . . . . . .SOUTH WINDSOR GRID CODE. .KO4H4
ADDREss. . . . . . . . . 101 HILLSIDE DR
NEAREST STREET. -SULLIVAN AVE
TYPE OF WORK. . . .EXC FOR MAIN SEWER LINE REPLACEMENT
REMARKS—WORKING PROM THE RIGHT REAR OF HOUSE TO RIGHT FRONT OF HOUSE.
EMERGENCY. CREW ON 'WAY TO SITE.
CALLER. . . . . . TAMMY RICHARDSON ALTER. . . . . . .
START DATE. . 05/09 START TIME—ASAP
PHONE # - -- . 727-9500 CALL BACK. . .7-5
CONTRACTOR. .ROTO ROOTER SVCS Co
ADDRESS. . . . . 15 BARBER POND VD, BLOOMFIELD, CT 06002
EXCAVATOR DOING WORK—SAME
W 1 +733 M SA
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y: 143.V Narm RM_#26T ELI.V.12 2
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