HomeMy WebLinkAboutWater Street Cut Permits 388 Strong Road Town of South Windsor , CT
Permit No. 3000 Street Excavation Permit
Date 08/02/2000 ^
Expiration Date 08/02/20C'1 r �
Descrip: MDC PATCH
Location
App 1 i cant.
0388 STRONG ROACH
Name M. J . D. CONSTRUCTION CO•
26 O T,yp�, of Work WATER
Addr • HARTFORDCT 06106
Phone (860 )953-8025
unt
Applicant agrees to furn ,sh
the Town o� South Windsor theeXmenseso.� bond
connection with this
required and to reimburse the'-Townf o orepaW nwork for any the rules and
Q the Town for maintenance
incurred by licar►t is` .famliar' with and will abide by
permit and that app
regulations
for permits as outlined in the Town of South Windsor' s street
Cut Permit Manual .
PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES .
Title
Issued by _�. ��.
Inspected By ----
Date Completed
soo
APPLICATION FOR STItEEVEXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm ro L4 (20 Phone No. etn 0 - 9C
Address of Fir 0cdt o , -5 . y
Location of proposed work 0;--ZI RA
Describe fully nature of permit requested C-A C
Starting da Approx.time for completion
Call Before You Dig No.,�!&oo-320 /66? Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North Prop.size of cut
No.cuts
Amt.of Deposit$ 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 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: Date: D $ O 2- 66
Title: 0
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc