HomeMy WebLinkAboutDriveway Street Cut Permits 129 Country Permit No. 2663 Town of South Windsor , CT
Date 04/26/1999 Street Excavation Permit
Expiration Date 04/25/2000
Desc r i p: esm.
Applicant
s Location
Name BOUTIN & SONS 12g COUNTRY VIEW DRI
Addr. 121 WINDSORVILLE R046,
BROAD BROOK C7 06016 ""Typef 1prtcRIVEWAY
Phone (860)623-2526
Applicant agrees o, t1r,� or the amount of bond
M
required and to re i m ttot
t^ "Tow h W` r f ' r any expenses
incurred by the Town connection with this
permit and that appli ate , a l:� 'bide by the rules and
regulations for permit 100 y
� � r r� o� uth Windsor s Street
Cut Permit Manual
* * PERMIT TO AT" ALL TIMES.
Issued by �. /y
'T tie
Date Completed Si � 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 $25.00
Name of Firm � QJ Ph ne No. �a 1 4o
Address of Firm (>rjj I,
Location of proposed work
Describe fully nature of permit requested
Starting date Approx.time for compiet' n
Cali Before You Dig No. f 9 9 9/,7 O 2 io o Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North Prop. size of cut
No.cuts
r Amt.of Deposit$ by
Cash O Check#
i Cut size after Perm. Patch
1 No. Cuts
Final Billing$
Amt. Due Payee$
J Amt. Due Town$
Applican esponsible 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 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:��L�,P rn � `�L a� Date:
Title: D.L.#•
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc _ __