HomeMy WebLinkAboutWater Street Cut Permits 1 Victorian Woo vvvv
Date 08/02/2000 Town of South Windsor, CT
Expiration Date 08/02/2001 Street Excavation Permit
Descrip . MDC PATCH
Applicant
Location
Name M. J . D. CONSTRUCTION CO.
Addr. 26 MONTROSE ST 0001 VICTORIAN WOODS
HARTFORD CT 06106
Phone (860)953-8025 Type of Work WATER
Applicant agrees to furn sh the Town of South Windsor the amount of
required and to reimburse the 'Town of South ,Windsor for any expenses bond
incurred by the Town for maintenance or repair work in connection with this
permit and that applicant is' 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 .
* PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES.
Issued by �
-- - Title
Date Completed /=
--- - —_ Inspected By ��
APPLICATION FOR STREET1EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSORf CT
FEE $25.00
Name of Firm Gc Phone No. 45'o - Q 7
Address of Firm Ad cc a
Location of proposed work C-
.de~ ai
! c-
Describe fully nature of permit requested c
Starting date 01R— O Approx.time for completion
Call Before You Dig No. Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North Prop.size of cut
No.cuts
Amt.of Deposit$ by
OCash O Check#
Cut size after Perm. Patch
No. Cuts
Final Billing$
Amt. Due Payee$
Amt. Due Town$
Applicant is responsible for contacting by
the Police Dept.and C.B.Y.D. 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 WINDSORIS STREET CUT PERMIT MANUAL.
Signed:
Date: O
Title: o � e
PERMIT SHALL BE KEPT ON]OBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc