HomeMy WebLinkAboutSanitary Main Street Cut Permits ECHN Si TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 4049
Location ECHN SITE 0ontrt4' SI "
CEO FARMS
Type Work SAN MAIN Addt ess ,p "
Date I
nsp Needed
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Time Insp Needed
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r Permit No. 4,049
Date 07/28/2005 Town of South Windsor, CT
Street Excavation Permit
Expiration Date 07/28/2006
Descrip: EXCAVATE TO INSTALL-`S$N
Pp cant F.
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Name SIMSCROFT ECHO BAR SLI Tr
Addr. P.O. BOX 581
A.
5
SI M S B URY CT 06070
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Phone (860)651-0231 �3 ,h WG� k S MAIN
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Applicant agreds Eo €tzxnisl the Tdwrt
'frith Wirt s he amount of bond
required and to reamburas bhe Town c3 u�� 1x1dsor
incurred by the ToQz an Y pnseswn fbrt?azliterfa3fe4rkn c4nnaeti`on with this
permit and that apF51x`cant ° : : .,. -r.;
:.i:amiliar with and wi:jj.i e , t,'
regulations :,;a,.<; "AW
and:. , Q:iz.:`
1:r• :.: y'. t:i ,•Windsor s Street
Cut Permit Manual. ':it;; ;;; ::
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Date Completed
By
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
F, TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR,CT 06074
FEE $25.00
Name of Firm_� N.� ��� - ��^-z M �� Phone No.
Address of Firm oZ ���,,. �1'a LaxE � ry s� ti C v(.,c> c�
Location of proposed work
Describe fully nature of permit requestedZr,��.l.S�
Starting dates �� \� 2 cxnra Approx.time for completion K
Call Before You Dig No. Z50 0,(,=-5 r`Q- Traffic Services Control No.
Show sketch of proposed work or furnish Indicate North This section to be filled out by
two copies of separate drawing Town of South Windsor
Pavement Cut
►'h No.cuts
Est.Size of Penn.Patch(s)
j Est.Pvt.Thickness in.
Est..Unit Price$
Amt.of Deposit S
! Total Due Zb by
i ' ( )Cash( )Check#
Permanent Patch
No. Cuts
Size of Patch(s)
�n
Final Billing
L
Amt.Due Payee
I. Amt.Due Town
BY
Applicant is responsible for contacting 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
PERMITS ED)N�THE TOWN SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: / Date: '"0
4= �
Driver's License#:
Title-
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES