HomeMy WebLinkAboutWater Street Cut Permits 131 Pine Knob D Permit No. 2317 Town of South Windsor , CT
Date 07/10/1997 Street Excavation Permit
Expiration Date 07/ 10/1998
Descrip : REPAIR WATER SERVICE
Applicant Location
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Name CONNECTICUT WATER COMPANY �0i31'' P.7�1E 1�NOB DRIVE
Addr . 25 NORTH ROAD
EAST WINDSOR CT 0608 € '7y.{ vf, .Wor4� WATER
Phone (860)292-5552
Applicant agrees to furnish the Town 'of ''South wijhds,or the amount of bond
required and to reimburse ,thy jowh of 800th W rxd or_f r any expenses
incurred by the Town 7r.;: rb i=n connection with this
permit and that app 1 i cam �i�. dmi +" �tk °:and _, i.�1, k i de by the rules and
regulations for permits aS out'l.i ned _i-h� tY�e 'Town, Sou th Windsor ' s Street
Cut Permit Manual .
PERMIT TO BE KEPT, ON ,JjOB 04TEI AT ALL TIMES .
Issued by � 0f C,/''aff T'itle`_r
Date Completed _ _
Inspected By
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APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
x PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE 25.00
Name of Firm a Phone No.
Address of Firm c'
Location of proposed work l
Describe fully nature of permit requested �
Starting date - / Approx.time for completion
Call before you dig no.�L'/rJ'�k( � a 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 S by
O Cash O Check#
Cut size after Perm. Patch
No.Cuts
r .
Final-Billing
�Qnb t e. X I Amt.Due Payee$
Amt.Due Town$
Applicant is responsible for contacting
the Police Dept.and C.B.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 SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: i� Date:
Title•
D.L.#
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES