HomeMy WebLinkAboutCut for sewer and water Street Cut Permi APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
`tl l �Amt. Bond Required PUBLIC WORKS DEPARTMENT _
Amt. on File TOWN HALL Permit ' 2225
Date of Expiration r 1540 SULLIVAN AVENUE Date
Ins. on File 0 Expiration Date{XYes O No SOUTH WINDSOR CT
FEE $25.00 Permit Expires
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Address
f Firm
of Firm
of proposed work � S Phone No.
Describe fully nature of permit requested-....
Starting date
Call before you dig No. Approx. time for completion s`
Traffic Services Control No.
Show sketch of proposed work or furnish To be glad out by Town of South Vllindso$�
o copies of separate drawing
Pavement Cut
_ Indicate North
Prop. size of cut .330 Jr re;
No. cuts
Amt. of Deposit $ 11AZ2�r 0 by �.
1
O Cash {Check #-��
Cut size after Perm Patch
No. Cuts
Final Billing $
Amt. Due Payee $ _.
Applicant is responsible for contacting Amt. Due Town $
the Police Dept. and C.B.Y.D.
by date
I agree to funish 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 rul s and regulations for permits as outlined in the Town of South Windsor's Stgeet Cut Permit Manual.
Signed: Title:
D.L.L.# Date: 7/7-
PEWrr SHALL ON T ALL ,nMES
APPROVED: DATE:7/ !
TOW NEER
FOR INSPECTOR Date work started 7-1y6 Date Completed -7�.,z
x
Signed .sue_ Date_ /T�
WHITE - PERMIT PINK ST. .SERVICES
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GOLDENROD - FINANCE
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