HomeMy WebLinkAboutMiscellaneous Street Cut Permits 302 Qua Permit No. 3024 Town of South Windsor, CT
Date , 09/07/2000 Street Excavation Permit
Expiration-'pate 09/07/2001
Descrip;-,'REPAIR SIDEWALK
Applicant Location
I
Name HOMEOWNER Q C3'21 QUA'RRY BROOK DRI
Addr. SAME AS ABOVE � .
SOUTH WINDSOR CT 06{ � T,j+pe cf, for i MISCELLAN
Phone (000)000-0000
Applicant agrees t ub "thi t ab# SoUh Windsor the amount of band
required and to reimbur80; t6 ; Town o� :Sots"fib Wdsor for any expenses
incurred by the Town fir .miaiyentce repay r;;'w4,rk,,in connection with this
permit and that appl scan is >;Tami l�;�arih ant:"wi.l I abide by the rules and
regulations for permit as r ►t ice` Towrk" f `South Windsor ' s Street
Cut Permit Manual .
* * PERMIT T4` BE 1tEPf _::(3N .JC?B BATE Afi..ALL TIMES.
Issued by �, G A T i t',Te �avS fc.-r
Date Completed Inspected By
APPLICATION FOR STREET EXCAVATION PERMIT
r TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm �iS��Iy re GL.�®, ,p phone No. S Address of Firm c¢ ,P d --
Location of proposed work /- �,,,, �� was ` ' G0
Describe fully nature of permit requested t.,i=r S�
Starting dated G7 4 Approx.AmnnY
Call Before You Dig No. - pp .fimn for completion , . 5&y y
Traffic Services Control No.
Show sketch of proposed work or furnish b o e filled out b Town of South Wirtd
two copies of separate drawing T sor
Pavemen ut
Indicate North
Prop.size of cut
f
No.cuts
Amt.of.Deposit$ by
OCash{)Check#
Cut size after Perm. Patch
No. Cuts
Final Billing$
Amt. Due Payee$
Amt. Due Town$
Applicant is responsible for contacting A
the Police De t..and C.B.Y.D. 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: /
Date:_ �!�T/D
Title:__��iyle dcy�ie' fa
PERMIT SHALL BE KEPT ON]OBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc