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HomeMy WebLinkAboutWater Street Cut Permits 20 Sharon Drive Date 08j02/2000 3.ao ,E Street Excavation Permit Expiration Date 08/02j20C1 -• Descrip: MDC PATCH Applicant Location Name M . J . D. CONSTRUCTION CO. 0020 SHARON DRIVE Addr .. 26 MONTROSE ST Type' of 'Work WATER HARTFORD CT 06106 Phone (860 )953-8025 Applicant agrees to furnis�i the 'Town of South n sor for rany e amount of bond expenses required and to reimburse the,Town ,of South W1n incurred by the Town for maintenance or repair work in connection with this permit and that applicant is famildainwthe Town and woflsouthe by Windsoer' sules Streeto regulations for permits, as out'l �ne Cut Permit Manual . * * PERMIT" TO BE KEPT ON JOB SITE AT ALL TIMES. Issued y :�' Date Completed Inspected By T a.Ir+ %f lotl, (iC r T + sir •�n�� C. APPLICATION FOR STREET tXCAVATION PERMIT TOWN OF SOOTH WINDSOR PUBLIC WORKS DEPARTMENT TOWN HALL 1540 SULLIVAN AVENUE SOUTH WINDSOR, CT FEE $250-00 Name of Firm �� v[ Phone N 'g® 2S Address of Firm 0jtq Ir o so, V- O6i 6 Location of proposed work o Describe fully nature of permit requested a Starting date v — © Approx.time for completion Call Before You Dig No. Traffic Services Control No. Show sketch ofproposed work or furnish s two copies of separate drawing To be filled out by Town of South Windsor Pavement Cut Indicate North Prop.size of cut No.cuts Amt.of Deposit$ by O Cash O Check# Cut size after Perm.Patch No. Cuts Final Billing$ Amt. Due Payee$ Amt. Due'rown$ 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: t Date: 4 — 0 ?— O o Title: PERMIT SHALL BE KEPT ON]OBSITE AT ALL TIMES Standard Forms\Permits\Street Excavation Permit.doc