HomeMy WebLinkAboutDriveway Street Cut Permits 374 Slater S �, Windsor , CT
Town or' out perm-It
Street Excavation
permit No, � 199' .�
Date N 11 /43,
Expiration Date 11iO3/ 199
i
Location
Descrp:
Applicant
0,�74 SLATED STREET
Name S&G INC . Type �f ,Wollrk DRIVEWAY
Addr. 144 SANDY BTA26029.
ELLINGTON
phone 1.41:3725-gts50 �ndsar the amount oi. bona
fioWn Of, Scsuth Wr. any expenses
Furnish the this
Applicant agrees to pf South YJiridsr i,n connection with
and to reimburse the e Town ai r Wl ', k the rules and
or� t�Ap i 1 l ab i de by
required wyth and w . u Street
incurred by the Town for m2cintanalJar the Town of truth Windsor
that applicant is" i'
permit and
ermi to as ", i rV6d i
regulations for p
out Permit Manual .
T ALL
t•. ERMIT KEPT 3N Jfl�. SITE A T'I
P TO
Issued by ynspected BY -- --- _____-- --
Date Comp l
APPLICATION FOR STREET EXCAVATION PERMIT
• TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
1540 SULLIVAN VAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm Phone No. L/13 `-rat y J o S C
Address of Firm S C' Pr w
Location of proposed work "5?
Describe fully nature of permit requested
Starting date Approx.time for completion_
Call before you dig no. /V 9 Traffic Services Control No. rl;i �{
Show sketch of proposed.work or furnish To be filled out by Town of So. Windsor
two copies of separate drawing Pavement Cut
Indicate North Prop.size of cut
No.cuts
Amt.of Deposit $ by
Cash(1 Check#
Cut size after Perm. Pate
No.Cuts
Final Billing$
Amt. Due Payee 6
Amt.Due Town $
Applicant is responsible for contacting
the Police Dept.and C.S.Y.D. by date
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: Date: I
Title: P_�Wf2- D.L.# bO �P U
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES