HomeMy WebLinkAboutDriveway Street Cut Permit 71 Autumn Dri Permit No. 2764 Town of South Windsor, CT
Date 07/14/1999 ` Street Excavation Permit
Expiration Date 07/13/2000 lc - L
Descri pc
Applicant 'k-A Location
BOUTI & SONS � 1� BUTNameX DRIVE
Addr. 121 WINDSORVILLE RQA ,
BROAD BROOK CT 06016a "
9R I V EWAY
�
Phone (860)623-2526
Applicant agrees r Sa ► nrdor the amount of bond
required and to reimtuez "foith 4�i+ � r� fgr any expenses
incurred by the Town for1en ' 3y` pal connection with this
permit and that a p p lant` Ixr ..... by the rules and
regulations for permits„ s� linrinqSc uth Windsor's Street
Cut Permit Manual.
* * PE MIT TO ol,$ATE � 'T.oLL TIMES.
Issued by
Date Comp 1 ete� �o,�'"' 7 _ Inspected By
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR -
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm i Pone No. a
Address,of firm
Location of proposed work
Describe fully nature of permit requested
Starting date Approx.time for completion
Call Before You Dig.No./9 9 9 2 l�'a i/� _ Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North Prop.size of cut
r No.cuts
Amt.of Deposits by
{)'Cash{)Check#
Cut size after Perm. Patch
No. Cuts
Final Billing$
l(, Amt. Due Payee$
Amt. Due Town$
Applicant is responsible f r 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 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: Date:
Title: D.L.#•
PERMIT SHALL.BE KEPT ON]OBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc