HomeMy WebLinkAboutEngineering Files_90788_pg0003 APPI ICATION fbR STREET EXCAVATION PERMIT
Appl.No. -'TOWN OF SOUTH WINDSOR Pe mit No.
PUBLIC WORKS DEPARTMENT A
_1540 SULLIVAN AVENUE Date:
SOUTH WINDSOR CT 06074
:FEE $25.00.
Name of Firm Phone No.
Address.of-Firm dip Code
Location of proposed work o
De own
fully rrature.of permit requested
Starting date /n
Apprm time,forcompletion
Cah Before.You Dig o: Existing Water_Supply: Q Public Water "(]Weli
Usting.Sewage Senrice �[ PubNc,Sewer ❑Septic
PLEASE I OTE:;.THE DEPOSIT.FOR THE PERMANEi�T PAYEMSNT PATCH'Aiiii CURB REPLACEMENT IS.A
PRELIMINARY; STIMATE. THE APPLICANTIS#IESPONSIBtE FOR THE FULL FlNAL COST OF THE
PER LATCH ANDOURS REPLACEMENT,INCLUDINak,'ANY iiNCREASE,S Ml PAT�3H AREA,.CURB
:LENQ7 1,T C CONTROL AND=THE TaWWI§CONTRACT:COSTS THE PERMANI`NT PATCH(IS TYPICALLY
COMPLtrTED.11VtTFI1N A YEAR:OF THE TEMPORARY:PATCH BUT IT COO BE LATER THAN A YEAR.
Show sketch of proposed work or furnish
finro copies of separate draHnng This to be out by
. : IrrcGcalb North Town off Windsor
No.cuts'.
Est.Patch Sizes) sf
Est.P t.Thiel ness in
Est.Patch Unit Price$ ./sf
Est.Patch Cost$
Est.Curb Repiaaerne. ft
Est.,Curb Unit Price$
Est.Curb Costs
t Est..Traffic Unit Cost$- /hr
Est:Traffic Control$
Amt.of Deposit$
Total Due$
(')Cash O Check#
Applicant is responsible for contacting Paid By
the Policy I)e
I AGREE TO FURNISH TO THE TOWN O SOUTH WINDSOR THE AMOUNT OF BOND REQUIRED AND TO REIMBURSE.THE
TOWN OF SOUTH WINDSOR FOR ANY EXPENSES INCURRED BY'THE TQWN i=OR MAINTENANCE OFt REPAfR WORK IN
CONNECTION WITH.THIS PERMIT AND THAT I AM,FAMILIAR WITH AND WILL ABIDE BY THE.RULES AND REGULATIONS FOR.
PERMIT$AS U LINSD IN_THE T. OF SOUTH WINDSOR'S STREEt'CUT PE( T MANU L.
Signed: Date.
Title: : Driver's License#
PLEASE ALLOW AT LEAST TWO WORKING DAYS AFTER APPLICATION FOR ISSUANCE OF"PERMIT
WORK MAY NOT BEGIN UNTIL A PERMIT HAS BEEN ISSUED :<
PERMIT SHALL BE KEPT ON JOB$ITE AT ALL TIMES
Street Excavation Permit 08 REV 10-22-08