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Permit No. 3050
Date 11/14/2000 Town of South Windsor, CT
Street Excavation Permit
Expiration Date 11/14/2001
Descrip: REMOVE TREES PER KARL REICHLE
Applicant Location
Name HOMEOWNERa . EYu DR. . AND CHARLIE CIRCLE
Addr. SAME AS ABOVE
SOUTH WINDSOR CT OQ " '
Phone 000)000-0000 TX d Wtit: MISCELLAN
Applicant agrees to f r ,Sh the Tow- o s ti "RW1ndsor the amount of bond
required and to reimk ur ® T0W � ;' mouth `W,,fh fir. fQr any expenses
incurred by the Town fay ttenanp .off .r�epa i r work_ in connection with this
permit and that applict "f arW4,thanti W1. , abide by the rules and
regulations for pe rm�is,,a ; 1e Ty o f
Cut Permit Manual . '"South Windsor's Street
`
ERMIT T( I 'AT ,,ALL . * �k
Issued bye"'"""
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Date Comp 1 to � , .
� , Inspected By
APPLICATION FOR STREET EXCAVATION PERMIT 30
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSORF CT
FEE $25.00
Name of Firm Lf-CoY1 L Phone No. b -5- 32 6
Address of Firm o .0
Ck to—
Location of proposed work i
Describe fully nature of permit requested
Starting date Approx.time for completion
Call Before You Dig No' Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North Prop. size of cut
No.cuts
Amt.of Deposit$ by
O Cash O Check#
Cut size after Perm. Patch
No. Cuts
Final Billing$
t,-Bde-Pay
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 SOUT WINDSOR'S STREET CUT PERMIT MANUAL.
Signed:
Date:
-
Title:
PERMIT SHALL BE KEPT ON]OBSITE AT ALL TIMES -
Standard Forms\Permits\Street Excavation Permit.doc