HomeMy WebLinkAboutWater Street Cut Permits 69 Woodland Dri (2) PermIt ,No.
Date
E;�fi� a rat Town
i on Townor
S Cate tl �r South
c.escv ,, q1 , ,,, Street � �`+ndsLr .
Ei�'{1f; N VALVE- � ralar`on Permit
Name CGNtvEG
TICUT
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Phone f .td i 3, �tduSR t; E �r6k;
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Applicant u
re urees to
purred and to re, ur"n�sh th
Incurred �mdurce t e ��'UWr1. sir South
per, j ,y the �o;�-n he. 7owr� Q South W ,r�c�,sc�r the amount
t and that oY m � ��r�dnceC?r �, 4N1Yidspr fir an un� or' pond
r era 1 at.7orlC for epp i 7 cant, 7s faint ipa7 r wprt�, Y expenses
cut PermIt permIte as oU�tliredar Q11h and . - 1 �t�` connection � � �
�'aar,Eaa i . ;r�, the ak Ide b �� this
7ctwr� y the rules and
�otitii ;N7YldSor 'S Str
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* PERMIT
Issued by -� ON 1.)(J -
ST7 A ALL QMES
Date con,o E e p _ r t l e
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9
TGI,y InsPected L-S•,�
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APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm Phone No. C�
Address of Firm
Location of proposed work 0—n
Describe fully nature of permit requested Q
Starting date 6111DLU Approx.time for completion
Call before you dig no. Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of So Windsor
two copies of separate drawing Pavement Cut
Indicate North Prop.size of cut
No.cuts
NAmt.of Deposit$ by
()Cash()Check#
o Cut size after Perm. Patch
bl
�rC No.Cuts
Final Billing$
Amt. Due Payee $
Amt.Due Town $
Applicant is responsible for contacting
the Police Dept. and C.B.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: � 1t.� �(,�Ll.t�� � Date:
gAlf
Title: D.L.#
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES