HomeMy WebLinkAboutWater Street Cut Permits 167 Newberry Ro Town of South Windsor , GT
Permit No. 30`�2 Street Excavation Permit
Date 08/02/2000
Expiration Date 08/02/2001
Descrip: MDC PATCH
Location
Applicant
Name M. J .D. CONSTRUCTION COS
p167 NEWeERRY ROAD
Addr. 26 MONTROSE ST Type of Wort: WATER
HARTFORD CT 06106
Phone (860 )953-8025
Applicant agrees to furnish the Town of South Windsnheeaensa of bond
pPs
required and to reimburse the Town of- south Windsor o or a
incurred by the Town for main�amaliarowithpand work
abide connection
rules this
permit and that applicant is.
regulations for permits as outlined in the Town of South Windsor' s Street
Cut Permit Manual .
* PERMIT TO FEE KEPT ON JOB SITE AT ALL TIMES.
Title
Issued by
Inspected By
Date Completed _
Tg
SOOZ
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm cA C 6 L'i c• Phone No. 9060
Address of Firm a y y 6
Location of proposed work r
Describe fully nature of permit requested OL c
Starting date -- 0 Approx.time for completion
Call Before You Dig No. g!0(p 0.'?2O /6l t/ Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate'drawing
Pavement Cut
Indicate North Prop.size of cut
No.cuts
Amt.of Deposit$ by
. O Cash O Check#
Cut size after Perm. Patch
No. Cuts
Final Billing$
Amt. Due Payee$
Amt. Due Town$
Applicant is responsible for contacting by date
the Police Dept. and C.B.Y.D.
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:_ 09— 6 2— c'� c)
Title: j
m
PERMIT SHALL BE KEPT ON 306SITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc