HomeMy WebLinkAboutWater Street Cut Permits 1140 Pleasant V Towr of south Windsor , CT
Perr i.t No. 29-56
St
reet Excavation Permit
Date 06/30 2000
Expiration Date 06:'30/2061
Oescr i p : WATER SERVICE TO PLEASANT MEADOWS SRO
If ` ,ation
Applicant Lc�
Name R . J . FTJOL :ANC P1*EASANT ;V,ALLEY4PLEASANT MEADOW
Adar . PO BOX 296
W. WARREN MA 01092 Type of Work WATER
Phone (.413 )463-5674
Applicant agrees to furnish the T4wr° of South Windsor the amount. of bond
required and to reimburse the Town of ,$.out.h Windsoj- for any expenses
inearred by the Town for maintenance or 11repai. r work in connection with this
pe rm i t and that app l i cant 1 s f ami 1 i!ar w'i th and, wi i 1 abide by the rules and
; egulat ohs for permsis as .o6t4ined n the Town Hof South Windsor' s Street
cut Permit Manual .
* *,, RER�JT -10 BF�- *APT ON JOB, SITE AT ALL TIMES. �
Titreissued by
Date Comp etec�, __L__- _
inspected By _—_____T—_______
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL '
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm Phone No. 41(3 i1.3
Address of Firm f--cs0 w. WA0-&t-t. ij W_ n�eti 01 A- 0 t 091L
Location of proposed work \ o P L,E A S A S
Describe fully nature of permit requested "r ivT. -r i is - `W Lj A;0L
Starting date �La: � »�Approx.time for completion to wtG_
Call Before You Dig No.2-0 0 O 22.0 3 o q Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North Prop.size of cut
No.cuts it
Amt.of Deposit l(0 by e
O Cash O Check#
Cut size after Perm. Patch
No. Cuts
waT `J% 1_TA� %M,- Final Billing$
Iz � ("
Pwu Amt. Due Payee$ -
P-A5�tATAmt. Due Town$
Applicant is responsible for contacting �y-�.t fov ►r _ by--,date
the Police Dept. and C.B.Y.D. ��(P t
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: �r V Date: .S-- 3 y- 01)
Title: G sT 11"'I ram. D.L.#:
PERMIT SHALL BE KEPT ON 306SITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc