HomeMy WebLinkAboutDriveway Street Cut Permits 135 Clark St Of SQUth QnOsor . CT
Date Street ExWevaslan Permit
E V CXP! ratlon Date DA/30/200-',
De6crip :
AuVicant Location
Name e BUT IN & SONS 4WAK&ARYSTREET
Addr , 121 WINOSGRVILLE ROAD
MAD BROCK CT 05016 Type of Work DRIVINAY
Phone 060023-2526
Applicaot agrees 00 foroish 0he Town Of South Windsor she amourt of oon(3
required and tc raimourse the TOwn Of South QnOscr fOr MY WPWS&S
incurrea ty the Town for maintenance or repair work jr connectjcn 01to tols
permit ano that appilcant is familiar with and will abide Wy the rules ano
reg"" SnS fOr PerMtS aS OULlined in the Town Of SOOth W0dsor ' s Street
Cut Permiz "annal .
PERMIT -Vid-E KEPT ON j08 SITE AT ALL TIMES ,
Issued t,,y
Date Comp"Qu
1nspectei,4, oy
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
LL
1540 SULLLIVAN AVENUE
SOUTH WINDSOR, CT l�
FEE $25.00
onst . Co .Name of Firm Boutin & Sons C pf,a1E No. 623-2526
Address of Firm Windsorville Road Broad Brook Ct 06016
Location of proposed work 135 Clark t r e e t
strl drivewa7 and di out lawn a
rea put in grnxml
Describe fully nature of permit requested_ and pave
Starting date �Approx.time for completion
Call before you dig no._ 20011702559 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 �C 2
14 Prop.size of cut
No.cuts
i
'All
L, 2 d Amt. of Deposit S by
i O Cash O Check#
76
Cut size after Perm. Patch
20 '
vI No. Cuts
Final Billing S
Amt. Due Payee $
Applicant is responsible for contacting Amt. Due Town $
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 RQIMBURSE 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:. 4/2 6/01
Secretary
Title:
D.L.#
PERMIT SHALL BE KEPT ON JOSSITE AT ALL TIMES