HomeMy WebLinkAboutDriveway Street Cut Permit 68 Autumn Dri Permit No. 2667 Town of South Windsor, CT
Date 05/03/1999 Street Excavation Permit
Expiration Date 05/02/2000
Descrip;
Applicant
Location
Name BOUTIN & SONS ;AAUTQM' N DRIVE
Addr. 121 WINDSORVILLE RCA, W
BROAD BROOK CT 06016 �
hype DRIVEWAY
Phone (860)623-2526 `
71
Applicant agrees i o t1 � f S ��, I1 Aor the amount of bond
required and to reimbe , # Town a h War fir any expenses
incurred by the Town connection with this
permit and that appl i� ar � abide by the rules and
regulations for permitsa's uth Windsor' s Street
Cut Permit Manual .
* * PERMIT TO ic ' �� � ALL TIMES.
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Issued by 'S �_f�n�A .,,
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A-,,Date Completed 4_116199 Inspected By
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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 $25.00
Name of Firm -l� S Phone No.
- -
Address of Firm 1 C -
Location of proposed work I-) r
Describe fully nature of permit requested a
Starting date Approx.time for completion
Cali Before You Dig No._l9 9244d,�! Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North Prop.,size of cut
No.cuts
Amt.of Deposit$. by
O Cash O Check#
Cut size after Perm. Patch
No. Cuts
1 Final Billing$ "
Z13 Q Amt. Due Payee$
Amt.Due Town$
Applicant is responsible for contacting by date
the Police Dept.and C.B Y.D.
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 W TH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR PERMITS AS OUTLINED IN THE
TOWN OF SOUTH WINDSOR`S STREET CUT PERMIT MANUAL.
Signed: )&,417 Date: v2eV
Title: D.L.#•
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
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Standard Forms\Permits\Street Excavation Permit.doc