HomeMy WebLinkAboutWater Street Cut Permits 176 Newberry Ro 'Rermi,t. No. 2696 Town of South Windsor, CT
Date 06/24/1999 Street Excavation Permit
Expiration Date 05/23/2000
Descrip: AND CK 3053
Applicant Location
Name JAMES THROWE 1 .r NEWBERRY ROAD
Addr. VANS SEWER & SEPTIC cps
VERNON CT 06066 T�!pek`� WATER
Phone (860)289-0095
Applicant agrees to orv`n .�6f .�AMh v W!,i dsor the amount of bond
required and to reimburad the 11'own,;of,�Sou1rh ' T i nr ..for any expenses
incurred by the Town fCrr ;intene !31" ,rpaih rkr connection with this
permit and that applicant' is famiiiar with and wi. 1 abide by the rules and
regulations for permits as:,outl'3rte�d in tfi4j,owi! ,of .,South Windsor's Street
Cut Permit Manual .
* * PERMIT T E .KEPT !( JOIO SITE ATI'ALL TIMES.
Issued by TIt,
Date Comple d Inspected By
a�tic�
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm V Phone No. V 9-5—
Address of Firm 1 ► .
Location of proposed work t
Describe fully nature of permit requested on
Starting date Approx.time for completion
Call Before You Dig No. a Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
9 ,
Pavement Cut
Indicate North Prop.size of cut 1
L7 No.cuts
Amt.of Deposit$ by
O Cash O Check#
Cut size after Perm. Patch
-� -- No. Cuts
l �
MAY n 1 ,/� �, 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 WINDSOWS STREET CUT PERMIT MANUAL.
Signed: Date:
Title: r'')IA)I)cr D.L.#•
PERMIT SHALL BE KEPT ON 308SITE AT ALL TIMES
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