HomeMy WebLinkAboutSewer and water Street Cut Permits 8 Rid E
APPLICATION FOR STREET EXCAVATION PER
TOWN OF SOUTH WINDSOR
Amt. on File MIT
Amt. Bond Required PUBLIC WORKS DEPARTMENT
TOWN HALL
'
Date of Expiration 1540 SULLIVAN AVENUE Permit 224
Ins. on File O Yes No SOUTH WINDSOR CT Date...
Expiration Date FEE $25.00 Permit Expires -- -�
Name of Firm
Address of Firm p�
Phone No. r 4Z
Location of proposed work e
Describe fully nature of permit requested
Starting date
Call before you dig No. Approx. time for completion
Traffic Services Control No.
Show sketch of proposed work or furnish
two copies of separate drawing To be filled p� by Town Of $q yyl
Ind! Pavement Cut
Prop. size of cut _ F
No. cuts
Amt. of Deposit $_. � by T«4-
Cash (4o<heck #
Cut size after Perm Patch
No. Cuts
Final Billing $
Amt. Due Payee $
ppp''
Applicant is .responsible for contacting Amt. Due Town $
the Police Dept. and C.B.Y.D.
by date
Windsor the amount of bond required and to reimburse the Town of South Windsor
I agree to funish to the Town of South
for any expenses incurred by the Town for maintenance or repair work in connection with this permit and that I am
familiar with an w' abide by the les and regulations for permits as outlined in the Town of South Windsor's Street Cut Permit Manual.
Signed: Title:_
D.L.L.# -'� ~y /
f ti Date:.
PERMrr SHALL BE KEPT JOBSfTE ALL TIMES
APPROVED: �,,
DATE:_
TOWN I LEER
FOR INSPECTOR: Date work started.
Date Completed
Signed Date
WHITE - PERMIT
_ _ .
PINK. -'ST: SERVICES
-�E>_L�W - ENGINEERING _ � y"°'
w. GOLDENROD - FINANCE