HomeMy WebLinkAboutWater Street Cut Permits 736 King Street �i _ ern Scut , "d ndscr < CT
Gate 1 n j 27 j 1997 Street ;=xcava-r,-11 on Permit,
Ex.piration late 10/27/ 1998
DescrIp
� �P 17 can t. 1 r C, i CJCI
Name !I H . W. L VAt; �� ! = � k,� t� REE
Addr . 49 MASCOLO ROAD
SOUTH WINDSOR CT 06074 TYPe of Wo;t,X WATER
Phone (860 )528-G131
Applicant agrees to furnish tl,e Town of South Windsor tt,te amount of bond
required and to reimburse ,"the Towt,t' ref South WilidOor for any expenses
incurred by the Town for ma,i;ntenance or repair work in'' connection with this
permit and that applicant is fami 71ar with and will �bide by the rules and
regulations for permits as outlined in the Town of South Windsor' s Street
Cut. Permit Manual .
PERMIT TO 'BE KEPT ibj( JOB ' SITE AT ALL TIMES.
Issued by - --`-,,-G's -fit-iH -- — Ti tie
Date Completed ______ Inspected By
APPLICATION FOR STREET EXCAVATIO
TOWN OF SOUTH WINDSOR N PERMIT
PUBLIC WORKS DEPARTMENT
1540 SULOLIV HALL
SOUTH WINDSOR, CT E
FEE $25.00
Name of Firm 72 Z-�
Address of Firm Pie No.
Location of proposed work
4
L
Describe fully nature of permit requested
Starting date
Call before you dig no. Approx.time for completion
Traffic Services Control No.
Show sketch of proposed work or furnish
two copies of separate drawing TO b ,filled out b
Town of
Indicate North So, Windsor
Pavement -�,t
Prop.size of cut
No.cuts
Amt.of Deposit$� Y
b
()Cash()Check#—
Cut size after Perm. Patch
No.Cuts
Final Billing$
Amt. Due Payee $
Applicant is responsible for contacting Amt. Due Town $
the Police Dept.and C.S.Y.D.
by date
I AGREE TO FURNISH TO THE TOWN OF SOUTH WINDSOR THE AMOUNT OF BOND R
SOUTH WINDSOR FOR ANY EXPENSES INCURRED BY THE TOWN FOR MAINTENANCE OR REPAIR WORK
PERMIT AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONSREQUIRED AND TO REIMBURSE THE TOWN OF
TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL. FOR PERMITS AS OUTLINED IN THE
IN CONNECTION WITH THIS
4 Signe y4,4
Date: /21 - �
Title: � �
D.L.#
PERMIT SHALL BE KEPT ON JOSSITE AT ALL TIMES