HomeMy WebLinkAboutDriveway Street Cut Permits 79 Pierce Ro APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm �� vIz , Phone No.
Address of Firm vs r'-d4 2 LA
Location of proposed work '7 1 `AeFrc r t
Describe fully nature of permit requested t
Starting date 9 Approx.time for completion -
Call before you dig no. i iH Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of So. Windsor
two copies of separate drawing Pavement Cut
Indicate North Prop.size of cut
No.cuts
Amt.of Deposit ffi by
).Cash()Check N
Ct� Cut size after Perm. Patch
No.Cuts
Final Billing ffi
Amt.Due Payee$
Amt.Due Town$
Applicant is responsible for contacting
the Police Dept.and C.S.Y.D. by date .
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 SO TH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: Date:
Title: D.L.#i
PERMIT SHALI SE-KEPT 0Off_JOSSI'SAT-ALL TIMES __----------------_ -_.------ - ----- ----:__-- ------ -----.__-----__- -----
Town of South W , ndsor , CT
Permi���Cao:.
2408 Street. Excavation Permit
Date 03�S(Jj1998 t
EXpir°ation Date 03J301gg `
Descrip: Location
Applicant
�E ROAD `
q+�7 3 .PIERCE'
Name BEAUSOLEI L , .lOSEPH �f Work DRIVEWAY
Addr , 105 EDGEWOOD DRIVE
SOUTH WINDSOR CT O60 4
Phone (850 ) 725-6490
the T,oWC1 Wi ndsor the amount of bond
Applicant agrees toftarn�'a1 .. �, W�nsr f'or any expenses
air �ri;r in connection with th i s
required and to reimburse trte° o the ru'�es and
incurred by the Towno.r rn
permit and that app i 7 cant i' m ahr� d � Sootyh Winde b dsor ` s Street
p� erm�ts'' as cU � 7nedn theTca +►
re
gu 1 ati ons for p '
Cut Permit Manual .
1 ALL TIMES .
* �x PERMIT TO 8tE 'T Q J SITS A,
t.
Issued by __-_____--_� = _ —
I,ncpected By
Date Completed