HomeMy WebLinkAboutDriveway Street Cut Permit 81 Alison Dri Permit No. 3658 Town of South Windsor, CT
Date 04/02/2004 Street Excavation Permit
Expiration Date 04/02/2005 >
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Applicant
LoeaT,ion
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Name BOUTIN & SONS '
Q$ ALIS0�3 aRT7J
Addr. 121 WINDSORVILL,E ROAD::-
BROAD BROOK CT `0.5,p> 6.:,::::.:..::...:::;`'><;. <ky:::;>.,.. ,:>
3; >2 Wc75k 17RI3J WAY
Phone (860) 623-2526 a
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Applicant agrees ci €ur s-4 the =Tr�ufi � f '
required and to reimburse thYTownOYEth Wide the mi
amount of bond
in :.�. _ th,I ;Tldsor '° 4 .,.<a.iiy.>escpenses
incurred by the Town:.<>'forttr�IYtetFclij�ei .3prkn cojlnpcton with this
permit and that apply .e'en} : amiar*^ra: }t atd'�.w311.3 a5..a:c by the rules and
regulations for perpia` > a>s okne1><::i: `:. ;;:; ::>:;;q'': '
3 ou_t1 Wintls�or s Street
Cut Permit Manual. €is" / `^?`'`"
* * .PERMITy 0V<.:
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Issued by � lTltl '
Date Completed
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
"Permit No. 3658 C)OUtir"a for BOUTI-11 ,SONS
Location 00$3 V iddr@ f 121rr I DSOR'V'I:LLE ROAD
Type Work DRIVEWAY
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Date Ins T
p Needed A.
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Work in Progress
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�� 1 L1VA11V1V rvtC 131Pcr ,r,1 V-AUAVA IUN PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT (�
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm Phone No. -
Address of Firm '
Location of proposed work
Describe fully nature of permit requested
Starting date Approx.time for completion
Call before you dig no. Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of SO WindSOr
two copies of separate drawing Pavement Cut
Indicate North Prop.size of cut
No.cuts
Amt. of Deposit S by
O Cash O Check#
Cut size after Perm. Patch
No.Cuts
j Final Billing$
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 WJNDSOR 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.
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Signed: �—t
Date:
Title:. D.L.#
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES