HomeMy WebLinkAboutWater Street Cut Permits 438 Strong Road Tow,'! i ,:youth f ndsc;r c
Permit No. 3�020
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Expiration Date 08/28/2001
Descrip :
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Appiicant
Name COVEN CONS1"Rl1C'fFION CO.
0438 STRONG ROAD
Addr .. P.O. 60X 427 Type of Work WATER
r.-�'OVENTRY CT 06238
Phone (860 )282-0526
App l s cant agrees to f urn i sh. the Town of south Windsor
i ndsor forany theeamountsof bond
required and to reimburse the Town of South Winds
incurred by the Town for
ontmasr�famai 1 annce owi thpand wi l 1 abide.air work in nbP then rules and
permit and that app ica with s
regulations for perm4ts as, outtihed in the Town Of South Windsor' s Street,
Cut Permit Manual .
* PERMIT T E KEPT ON .3OB SITE AT ALL TIMES
Issued by
Gate Comp 1 eted
Inspected By
3oao
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm G✓Jcof04 Phone No}''v O DV (�7
Address of Firm--h� 0 y U LF� .
,�
Location of proposed work
Describe fully nature of permit requested
Starting date V Approx time for completion
Call Before You Dig No. Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing -
Pavement Cut x�
Indicate North Prop.size of cut z4 S I¢
No.cuts I
Amt.of Deposit$-ALJI by
�U �� O Cash O Check# /oS.
! Cut size after Perm. Patch
(� No. Cuts
(1174 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 ST EET CUT PERMIT MANUAL.
! p
Signed: Date: O 00
Title: ►1.,
PERMIT SHALL BE KEPT ON]OBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc