HomeMy WebLinkAboutDriveway Street Cut Permits 20 Skyline D Permit No. 2799
gate i 08/05/199 Town of South Windsor, CT
Street Excavation Permit
Expiration Date 08/04/2000 13
D@scrip:
Applicant Location
Name E.C, PAVING ,,, 0020,SKYLINE DRIVE
Addr. 139 WETHERELL ST
MANCHESTER CT 06040 TypQ`'c f Work DRIVEWAY
Phone. (860)647-9834
Applicant agrees to °1'u Tsh the tQ�r ;of South Windsor the amount of bond
required and to reimbu:rs the Town cif So"th ; lindsor for any expenses
incurred by the Town fear intenance repay WO - n connection with this
permit and that app1 cant 's fami !var j,th and w� :l1 abide by the rules and
regulations for permits attl,iti`, n :'tie Town of South Windsor's Street
Cut Permit Manual . "
* * PERMIT TO" BE KEPT O .J0$ 'SITE AT ALL TIMES. * �k
Issued by
Title .�, ,� s
Date Completed _ Inspected By
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm 1AX- C one No:- �- d p.3q
Address of Firm
Location of proposed work
Describe fully nature o permit r nested
Starting date S� Approx.time for completion
Call qefore You Dig No. Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town_of South Windsor
two copies of separate drawing
Pavement
Indicate North Prop.size of cut
No.cuts
Amt.of Deposit$ by
OCash{)Check#
�( Cut size after Perm. Patch
No. Cuts
--t
Final Billing$
.q-pao
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 TH I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR PERMITS AS OUTLINED IN THE
TOWN OF SOUT NDSOR'S STREET CUT PERMIT MANUAL.
Signed• y Date:
Title Dk D.L.#:
PERMIT SHALL BE KEPT ON]OBSITE AT ALL TIMES
Standard FormsWermitAStreet Excavation Permitdoc