HomeMy WebLinkAboutDriveway Street Cut Permits 88 Palmer Dr Permi t No. 3107 � '�''` '�/I�'Qi
Date 05/O8/2pp1 Town of South Windsor, CT
Expiration Date p,�/08�2p02 Street Excavation Permit
Descrip:
Applicant
1.00at 1 Otl
. Name BLUE DIAMOND �pAyINC I�� � � �� ��
Addr. 1p64 EAST ST NOR�fH
SUFFIELD, CT 06078�� � m � '� ;���� �.�
Phone (800)728-4644 � �' � � �' ��
3YPe�,'of'.►�r�c ,DRIVEWAY
_�.
APPl i cani; agrees to ~fui�t�;7sf�� the T ^
required and to reimbus� � ;�'ToWr�. o�Scuth WUndsorn�orranhe amount of bond
incurred by the Town �fo�r �a-�ntehan� ��' �^epai �, �,��,� i� connect�onsw�t
permit and that app 7 i���� �� ��f` ��� h �i�i='t� and h th i s
regulations for permits:: a�' `cutlirte�d'�'tn tta� `Twin,�of�SgbtheWb�dsoe'suStreetd
Cut Permit Manual .
* � P� RMIT T4 � KEPT �N� � ��
.�UB: '$�,��1'E AT ALL TIMES. * �
Issued by = � �
( � T i't'l.e j C�'7,ti 1�. -,�,,,..�
Date Comp 1 eted�' o�
�'�;�--� - Inspected 8y
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APPLICATION FOR STREET EXCAVATION PERMIT d
TOWN OF SOUTH-�IVINDSOR 3
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH-WINDSOR, CT
FEE $25.00
Name of Firm, Phone No. 50
Address of Firm 6 c,r 7-3 e i—
Location of proposed work d%i u
Describe fully nature of permit requested c c x; 14a 1e„.I A(r-dc f,
Starting date 6 Approx.time for completion b alc. ,S
Call Before You Dig No.XI 1_7da Sa-7 Traffic Services Control No.
Show sketch of proposed work or furnish To be ffi NiNed out by Town of South Windsor
two copies of separate drawing
PavemNt Cut
Indicate North .E It) Prop.size of cut_ItIon e.r _
No.cuts
Amt.of Deposit$ by
17 {}Cash O Check#
Cut size after Penn. Patch
- No. Cuts
y
qt 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
sours•'tWND.�.-OR FOR AN S(PENJES INCURRED SY THE TOWN rOR MAINTENANCE OR REPAIR WORK IN CONNECTION iiV!T H 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 WINDSORIS STREET CUT PERMIT MANUAL.
Signed: cz Date: ?y d /
Title: l/2P.�.rl.� D.L.#•
PERMIT SHALL BE KEPT ON 70BSITE AT ALL TIME
Standard Fbrms\Permits\Street Excavation.Permit.doc