HomeMy WebLinkAboutWater Street Cut Permits 25 Palme Drive TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 4995
Contractor CONNECTICUT WATER COMPANY
Location 0025 PALMER DRIVE
Type Work WATER Address 25 NORTH ROAD
EAST WINDSOR CT 06088
'hone No. (860)292-5552
Date Insp Needed
Date, Insp.
Time Insp Needed
1`ime In60.,
Inspected By
Work in Progress
!� a 3:
77r_14
Input Date
Permit No. 4995
Date 0110212001 i OMlr1 of South Windsor, C r
Street Excavation Permit
Expiration Date 01 /02/2002
Descrip:
Applicant I,
° Location
Name CONNECTICUT WATER COMPANY
Addr. 25 NORTH ROAD PALMER DRIVE
EAST WINDSOR CT 084$8 �
Phone (860 )292-5552 .:Qf Work WATER
Applicant agrees' fro ,"icurn4;0h theSauth Windsor the amount
required and to remb�ut T�° : ,outU% nclsor, for any expenses
of band
incurred by the 'To
n f r ao nteri n - repa fi W rk: i n connection with this
permit and that a I n „ s f� nth } I rk, in de b the
regulations for Y rules and
per i l ou r f t �-,o" Of `South Windsor ' s Street
Cut Permit Manual . _ry
PERMITS T,
� 4 fd � E tit Ciq, QZTE AT' ALL TIMES. �
Issued by
T 1 cle
Gate Completed s/ --
Inspected By
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WIbjDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm J
Address of Firm , Phone No. ® i � j � 102
Location of proposed workIL 104
Describe fully nature of permit requestedA, 7777TA7
Starting date Approx.time for completion
Call Before You Did No. Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
L Pavement Cut
Indicate No h bye Prop.size of Cut
No.cuts
Amt.of Deposit$ by
{)Cash{)Check#
Cut size after Perm. Patch
No. Cuts
Final Billing$
Afnt. 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: �' 0�.L� Date:
Title: D.L.#•
PERMIT SHALL BE KEPT ON 30BSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc