HomeMy WebLinkAboutWater Street Cut Permits 87 Stanley Driv Permit No.
Date 3007
08/02/2000
Expiration Town of South Windsor,
Descri Date 08/02/2001 Stree� Excavation CT
p MDC PATCH cn Permit
Applicant
Name M. J.D.
Addr, CONSTRUCTION Co. Location
26 MONTROSE ST
HARTFORD CT
6106 0087 STANLEY DRIVE
Phone (860)953-8025
Type of Work WATER
Applicant agrees to furnish the
required and to
incurred b reimburse the Towh of South Windsor
Y the Town far Town of South W the amount
Permit and that maintenance Windsor for of bond
regulation:; applicant is or repair work in
any expenses
Cut for ManrPermlc familiar with connection With
as outlined and will' abide by the this
7n the Town of South Windsor 's and
s Street
PERMIT To BE `KEPT ON .14C
Issued by •� SITE AT ALL TIMES.
Date Completed Title
Inspected BY
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm - C�c- L Ph—o e No._,�60 - -Ao Address of Firm 7 r
Location of proposed work _o -
Describe fully nature of permit requested
Starting date _ a - o o Approx.time for completion
Call Before You Dig No. :�2®o o 3zO yi Traffic Services Control No.
Show sketch of proposed work or furnish To be fills out Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North Prop. size of cut
No.cuts
Amt.of Deposit$ by
O Cash O Check#
Cut size after Perm. Patch
No. Cuts
Final Billing$
Amt. Due Payee$
Amt. Due Town$
Applicant is responsible for contacting by date
the Police De t.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 PEi2MITS AS OUTLINED IN THE
TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: Date: n g, D 2-®o
Title:_ �ool�.�o��lc r
PERMIT SHALL BE KEPT ON 308SITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc