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HomeMy WebLinkAboutWater Street Cut Permits 200 Kelly Road APPLICATION FOR STREET EXCAVATION PERMIT TOWN OF SOUTH WINDSOR PUBLIC WORKS DEPARTMENT TOWN HALL 1540 SULLIVAN AVENUE SOUTH WINDSOR, CT FEE $25.00 Name of Firm .Phone No. Address of Firm Location of proposed work Describe fully nature of permit requested 14 w 7K ylr Starting date - - Approx.time for completion Call before you dig no.�'� 1744 3 1 Traffic Services Control No. Show sketch of proposed work or furnish To be filled out by Town of So. Windsor two copies of separate drawing Pavement Cut — - Indicate North Prop.size of cut No.cuts tj Amt.of Deposit$ by Cash()Check# \ Cut size after Perm. Patch No.Cuts Final Billing$ �U Amt.Due Payee$ Amt.Due Town$ Applicant is responsible for contacting 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 (�l�,CX JT .{ �UL.Z �h Date Title- Vp�ytkvA 614 D.L.# PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES Town of South Windsor , CT Permmit-Nc;. 2319 Street Excavation Permit Date 07/23/1997 Expiration Date 07/23/1998 Descrip: Location Applicant Name CONNECTIC�UT WATER COMPANY (32C70 KELLY ROAD Addr . 25 NORTH ROAD Type of:-Work WATER EAST WINDSOR CT 06088, Phone (860)292-5552 Applicant agrees to furnish the Town of South. Wi�faoranr�eeapensesof bond pp required and to reimburse ,the" Tow''' 'of,, Bou h W `w6rth incurred by the Town fo'r mainCena t ar ?w� h airI ar�dw w 11 abidenbyCthenrules ands permit and that applicant �s f am7 regulations for permits outlined in the. To P 4f South Windsor' s Street Cut Permit Manual . * PERMIT fiO BE KEPT Ot4.J©B ''8I7E AT -ALL TIMES. s Tit;16Issued by _�'�-_��`` ✓ v Inspected BY ----- Date Completed _---,---