HomeMy WebLinkAboutWater Street Cut Permits 1140 Pleasant V (2) Permit No. 3056 Town of South Windsorr, CT
Date 12/07/2000 . Street Excavation Permit
Expiration Date 12/07/2001
Descrip, PLEASANT MEADOWS WATER MAIN
Applicant Location
Name R. J . FIJOL INCH'
1 T, 0 PLEASANT VALLEY
Addr. PO BOX 296
W. WARREN MA 01092 Type off:=< Wcsrk. WATER
Phone (413)463-5674
App? i c a n t agrees thy the amount of bond
requi red and to reimbu"e; To o=^ 'thffrvjU
o ._.,fpr any expenses
incurred by the Towner8rrc - 1^.Epai r~"Wor k, i connection with this
permit and that appl ,°°cariir arfaR1yI i antl. i'1 I, abide by the rules and
regulations for permits
VA: Tow, of mSc'uth Windsor 's Street
Cut Permit Manual .
* * PERMIT To"Ojf-,`KEPT` YQN J:t SITE, T. AAiL TIMES.
Issued by .� ��
Date Completed -Inspected By
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
I FEE $25.00
Name of Firm I
Phone No. /
Address of Firm
Location of proposed work /G!
Describe fully nature of permit requested P L
Starting date Approx.time for completion I Lbw
Call Before You Dig No. Traffic Services Control No.
Show sketch of proposed work or furnish two copies of separate drawing To be filled out by Town of South Windsor
Pavement Cut
Indicate North Prop.size of cut X 3
T
No.cuts
n Amt.of Deposit ad by
OCash OCheck# /S Lp
Cut size after Perm. Patch
No. Cuts
Final Billing$
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 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: (�G ��
Date:
Title:__
PERMIT SHALL BE KEPT ON]OBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc