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HomeMy WebLinkAboutSanitary Lateral Street Cut Permits 19 W Permit No. Date `35`� 09/23/1997 Town of Exp i r"a " South sor, CT t i on Date Dg/ iyB Street Excavati/ondPermit Descr-rp: CI°;3962 ISFORP PATCH FEE & Ck2398 IS FOR PERMIT FEE Applicant Name SIMSCROFT ECHO FARMS Location Addr. P.O. BOX 581WLLES LANE Phone SIMSBSRY CT 06070 1 type", 4f Word NEW SAN LAT Applicant agrees to furni sh required and to reimburse the Town of " incurred b s the ��ow of $OuthSouth,WWihdsor Y the Town 7nd' , the amount of bond permit and that for mairitenance car. repair +�arA for any expenses regulations for applicant, is famil ar� wti b connection with this Cut Permit permits as` ©utlined in and will abide by the rules and Manual . the Town cif South Windsor 's Street * *• PERMIT TO PE KEPT ON d46; S Issued by r I' E AT ALL TIMES. Ti,tl,e Datei r Completed r -7 — - Inspected By APPLICATION FOR STREET EXCAVATION PERMIT TOWN OF SOUTH WINDSOR PUBLIC WORKS TOWN H DEPARTMENT �4 1540 SULLIVAN AVENUE 2° SOUTH WINDSOR, CT FEE $25.00 Name of Firm F r Ac CIO J;C•Phone No. 0 ro S$ _ .?C 7 6 Address of Firm Location of proposed work - tt L47J I- Describe fully nature of permit requested „SC w r✓y ,Z—ow Starting date 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 So Windsor two copies of separate drawing Pavement Cut Indicate North Prop. size of cut_ No.cuts Amt. of Deposit$ �L� ', byJ r ()Cash ACheck# L- Z 398 ave# LAer-00", Cut size after Perm. Patch No.Cuts Final Billing$ Amt.Due Payee $ Amt. Due Town$ Applicant is responsible for contacting the Police Dept.and C.S.Y.D. by 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 WINDSOR'S STREET CUT PERMIT MANUAL. Signed: DP6 �— Date: Title: t ( ' D.L.# _ d�' Z C V 7 PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES