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Perrrit No. 2269 Town of South Windsor-, CT
Date 01 /06/ 1997 Street Excavation Permit
Expiration Date 01 /06/ 1998
Descrip: IRAFFIC' LIGHT LOOPS Al INTERSECIIOM SL.AIER AND RIE . 31.1
Name C ONNEC1 ICU 1 WA-i`Ek CQf4PAN r' R S i' A F Rl k . 3t)
Addr•. 25 NORTH ROAD
EAST" WINDSOR 61' ObO88 Type of Work MTSCELLAN
Phone (660 )292-5552
Applicant agrees to furnish the Town of South Windsor the amount, of bond
required and to reimburse the Town of i outh windsor for any expenses
incurred by the Town for maintenance or repair work in connection with this
permit and that applicant is familiar with acid will abide by the rules and
regulations for permits as outlined n the Town of South Windsor' s Street
Cut Permit Manual .
PERMI F TO Bt KEPT ,ON JOB SITE AT ALL TIMES.
Issued by T'i t 18 -- �
Date Completed incpe`=Leo By c/
TOWN OF SOUTH WINDSOR INSPECTION RFPOR",
Dermit No. 2269 Contractor CONNECTICUT WATER COMPANY
_ovation SLATER S1" Al- I±I F: , 110 Address 25 NORTH ROAD
Type work MISCELLAN EAST WINDSOR CT 06088
Phone Tutu. ( 860)292-5504
late i nsp Needed _ »/ /// _ Date ;Cnup .
rime I nsp Needed ---__-.---- ___--__._---- _ .rime Insp..
Inspected By
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i APPLICATION FOR STREET EXCAVATION PERMIT
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WI DSOR, CT
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Name of Firm �� G> 9: �.�, <�-vY Phone No.
Address of Firm �—
Location of proposed work
Describe fully nature of permit requested
Starting date /����? Approx.time for completion /2,vY.S
Call before you dig no. Traffic Services Control No.
Show sketch of proposed work or furnish TO be filled Out by TOM Of SO Windsor
two copies of separate drawing Pavement Cut
Indicate North —�_ Prop.size of cut D k fa
n�pti
No.cuts
Amt.of Deposit$ by
ram.to
O Cash O Check# ot1
�� trf c�j= h/9r Cut size after Perm. Patch
o-
41` No.Cuts
U Final Billing$
Amt.Due Payee $
y
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: f
Date: 11111.17e,
Title' �sVC��ii.��/Z D.L.#
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES