HomeMy WebLinkAboutDriveway apron Street Cut Permit 10 Andm Fermi t No. 3409
" Date 10/02/2002 Town of South Windsor, i
Street Excavation Permil
Expiration Date 10/02/2003
Descrip: DRIVEWAY APRON
Applicant
Location,
Name BOUTIN & SONS 6<0 A DMAR LANE
Addr. 121 WINDSORVILL
BROAD BROOK CT ork DRIVEWAY
Phone (860)623-2526 * -
Applicant agr s indsor the amount of bond
required and to h So ndV r for any expenses
Incurred by the ain r r -Vo k in connection with this
Permit and that a phi it i 1 abide by the rules and
regulations for p r South Windsor's Street
Cut Permit Manual .
o Q
* * PERM T ALL TIMES.
Issued by
t le _ 9":j
Date Completed
Inspected By
TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 3-409 Contractor BOUTIN & SONS
Location "ice °' Ra, Address 121 WINDSORVILL'E ROAD
Type Work DRIVEWAY BROAD BROOK CT 06016
hone No. (860)623-2526
Date Insp Needed �'
Xe sp. /1/7}lAa
Time Insp Needed �,r36A91
Inspected By
Work in Progress _
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. �I t Date _ c
' APPLICATION FOR STREET EXCAVATION PERMIT y��
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 115 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 Pavemen 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
Final Billing S
Amt. Due Payee S
S
Applicant is responsible for contacting Amt. Due Town
the Police Dept. and C.B.Y.D. by date
I AGREE Tp 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 J 1�nl
Date: `j
_ G
Title: OUP', D.L.#
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES