HomeMy WebLinkAboutWater Street Cut Permits 565 Pleasant Va �32Zo
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDS
FEE $25.00
Name of Firm � ` Phone No.
Address of Firm r,,r-(VTM 51 7'F1Z, C, 0
Location of proposed work PLre,,"I%M"I P6 &V A tCl—A (e 0
Describe fully nature of permit requested (�'� sPLV` w►'V 351- 5
1 -
Starting date f/ 1 i 0( App=time for completion
Cali Before You Dig No. 'Zc�a 1 410 12 7 0 Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
Pavement
Indicate North UE-1�eUO5 *M,9)n l�a`�� Prop.size of at 6
No.arts
'Amt of Deposit$ >V�� by
O Cali O Check#
AL
Cut size after Perm. Patch
1-�-r
GLIA-7-�f0v No. Outs
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 WINDS R FOR ANY EXPENSES INCURRED BY THE TOWN FOR MAINTENANCE OR REPAIR WORK IN CONNECTION WITH THIS
PERMIT AND T"ATJ AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR PERMITS AS OUTLINED IN THE
TOWN OF SOU`�&WINDSOR'S STREET CUT PERMIT MANUAL
Signed. Date: /D 1Z 3/1 1
Title:— D.L#•
PERMIT SHALL BE KEPT ON]OBSITE AT ALL TIMES
Standard Forms\Perrnits\Street Excavation Permitdoc